Complication Of Percutaneous Nephrostomy Research Articles

Intrathoracic ureteric stent migration through a reno-pleural fistula: a case report of rare antegrade ureteric stenting complication

BackgroundMalignant obstruction and associated hydronephrosis is a common complication of advanced cervical cancer. Percutaneous nephrostomy (PCN) followed by antegrade stenting is often required to relieve obstruction as retrograde access fails in considerable proportion of such patients. Reno-pleural fistula is a rare complication of PCN which creates a patent connection between the renal collecting system and the thoracic cavity, and urine accumulation in the pleural space can cause pleural effusion (i.e., urinothorax). Upward or downward migration is a complication of indwelling ureteric stents. Further migration with extrusion outside of the urinary tract is uncommon. Herein we present an unprecedented case in adult of ureteric stent upward migration through a reno-pleural fistula into the thoracic cavity managed by thoracoscopy.Case presentationA 66-year-old female was diagnosed of advanced stage cervical cancer with suspicious bladder invasion. Given her bilateral hydronephrosis with impaired renal function, she underwent bilateral PCN and subsequent antegrade ureteric stenting. However, she presented with dyspnea, right back pain, and oliguria four days after bilateral PCN catheter removal. Computed tomography reported massive right pleural effusion and an intrathoracic ureteric stent within reno-pleural fistula. Thoracoscopy with thoracostomy was performed to remove the ureteric stent and urine in right pleural space. A week later, urinothorax had resolved and right PCN was performed again. She was discharged after regaining normal renal function with right PCN and a left ureteric stent in place.ConclusionsA reno-pleural fistula can serve as a route for ureteric stent migration and that continuous drainage of urine can cause urinothorax once the stent reaches the thoracic cavity. Anytime a supracostal approach is used for PCN, even when using small caliber catheters, clinicians should pay special attention given the risk of pleural injury and subsequent complications.

Incidental misplacement of a percutaneous nephrostomy tube in the inferior vena cava

Introduction. An isolated renal pelvis rupture is a rare type of blunt renal trauma that can occur mostly in patients with pre-existing hydronephrosis due to different causes. We presented a patient with the misplacement of a percutaneous nephrostomy tube during the treatment of isolated renal pelvis rupture in a patient with pre-existing hydronephrosis caused by post-irradiation ureteral stricture. Case report. A 36-year-old woman was referred to our institution by her gynaecologist for the treatment of a retroperitoneal urinoma. She had completed the irradiation treatment with concurrent cisplatin chemotherapy for a uterine malignancy one year ago. A computed tomography scan showed an isolated rupture of the left renal pelvis with the pre-existing hydronephrosis. A nephrostomy catheter was misplaced in the inferior vena cava during the percutaneous urinary drainage attempt. The patient underwent a laparotomy, renal pelvis suture and ureteroneocystostomy with an indwelling double pigtail stent. The percutaneous nephrostomy was removed during the same surgical procedure. Conclusion. Inadvertent injury of vascular structures is a possible complication of percutaneous nephrostomy under ultrasound guidance. It may have been possible to avoid the reported complication if the dilation of the nephrostomy tract over the guidewire had been performed under contrast-enhanced X-ray fluoroscopy.

Complications of percutaneous nephrostomy in a district general hospital.

Percutaneous nephrostomy (PCN) is one of the commonest procedures performed. There are currently no European recommendations on the accepted rate of complications. The aim of the present study is to report the complication rate of PCN with the specific emphasis on sepsis and septic shock, the causative organisms, sensitivities to antibiotics, and associated risk factors. Retrospectively collected data on patients undergoing acute or elective PCN at the Department of Radiology, Countess of Chester Hospital (COCH), in the UK between January 2014 and December 2016 were analyzed after the study was approved by Local Audit Department at COCH. A total of 66 patients underwent 90 acute or elective PCNs. Three patients developed major post-PCN complication (two patients developed septic shock and the third suffered a hemorrhagic episode requiring blood transfusion). Nephrostomy tube complications (blockage, leaking, fracturing and kinking of the catheter) occurred in 4 patients. Complications were more common when the PCN was performed out of working hours (71.4% [10/14], and 17.3% [9/52] for PCNs performed within, and out of working hours, respectively: p<0.001). The age of the patients did not seem to correlate with the development of complications (p<0.001). Of all 25 patients, in whom septicemia was diagnosed prior to PCN tube insertion, 12 developed septic shock and 13 had signs of sepsis for longer than 24 h. Fifteen patients had positive urine cultures. The most common organism isolated was Escherichia coli. Blood culture isolates included: Escherichia coli, Eggerthella lenta, Enterococcus, Proteus mirabilis, Pseudomonas aeruginosa and Streptococcus pneumonia. Our complication rates were within United States proposed target ranges. Our data may help to serve as a baseline for outcome targets in the European centres.

Comparison between the use of percutaneous nephrostomy and internal ureteral stenting in the management of long-term ureteral obstructions

ObjectivesIn this study, we compared between the efficacy and complications of percutaneous nephrostomy (PCN) tubes and those of internal ureteral stents (e.g., double-J stents) used for relieving ureteral obstructions. Materials and methodsA retrospective chart review was performed. Between 2003 and 2009, 110 patients (63 females and 47 males, with a mean age of 63.6 years, range 19–89 years) who had an extrinsic ureteral obstruction, and subsequently underwent either PCN tube placement (n = 44) or internal ureteral stent placement (n = 66), were enrolled. Clinical data on patients with duration of diversion/drainage for more than 6 months were collected. Statistical analyses were performed with respect to a patient's age, etiology of the obstruction, outcome of residual hydronephrosis, and renal function tests. ResultsPatient ages and procedure-related complications were comparable between these two groups. The mean duration of diversion was 16.8 ± 8.6 months in the stent group versus 14.1 ± 6.7 months in the PCN group (p = 0.067). A smaller elevation in serum creatinine was noted in the PCN group (0.21 vs. 0.78 mg/dL, p = 0.03). Nine of 86 (10.4%) double-J stents were converted to PCN tubes during the study period. Residual hydronephrosis after decompression was more common in the stent group than in the PCN group (65.2% vs. 27.2%, p = 0.01). These findings suggest better preservation of renal function by a PCN tube. ConclusionsResults of this study suggest that, to better preserve renal function, PCN is the choice of treatment, irrespective of the etiology. While patients who have a PCN tube may have to carry an additional external drainage device, the complications did not seem to differ significantly from those who used internal drainage with a ureteral stent. Because young cancer patients may especially need aggressive chemotherapy to prolong their survival, PCN urinary drainage may become a better choice from the standpoint of cancer control.

Evidence-Based Drainage of Infected Hydronephrosis Secondary to Ureteric Calculi

The obstructed, infected kidney is a urological emergency. It has been accepted that the management of infected hydronephrosis secondary to ureteric stones is through prompt decompression of the collecting system. However, the optimal method of decompression has yet to be established. A PubMed and Medline search was performed of all English-language articles from 1960 using key words "sepsis," "urosepsis," "obstruction," "obstructive pyelonephritis," "pyonephrosis," "infection and hydronephrosis" "decompression," "stent," "nephrostomy," and "management." The Cochrane database and National Institute for Clinical Effectiveness guidelines were searched using the terms "sepsis," "urosepsis," "stent," "nephrostomy," or "obstruction." Scottish intercollegiate guidelines were reviewed and no relevant guidance was identified. Two randomised trials have compared retrograde stent insertion with percutaneous nephrostomy with one trial reporting specifically on patients with acute sepsis and obstruction. Neither trial showed one superior modality of decompression in effecting decompression and resolution of sepsis. A further literature search regarding the complications of percutaneous nephrostomy and stent insertion was carried out. An overall major complication rate from percutaneous nephrostomy insertion was found to be 4%, although the complication rates from stent insertion are less consistently reported. There appears little evidence to suggest that retrograde stent insertion leads to increased bacteraemia or is significantly more hazardous in the setting of acute obstruction. Further region-wide discussion between urologists and interventional radiologists is required to establish management protocols for these acutely unwell patients.

Palliative percutaneous nephrostomy in recurrent cervical cancer: Retrospective analysis of 50 consecutive cases

19609 Background: Cervical cancer is a public health problem in Brazil, with annual incidence rates of 20 to 40 cases/ 100.000 women. Most patients with recurrent disease have local symptoms and develop renal failure. There are no clear guidelines to predict which patients in palliative care derive benefit from percutaneous nephrostomy (PN) in terms of survival and quality of life. This study aims to evaluate the outcome of patients with recurrent cervical cancer in palliative care submitted to PN and thereby identify those who can potentially benefit from this intervention. Methods: Retrospective chart review of all patients assisted in the Palliative Care Unit of Brazilian National Cancer Institute from January 2002 to October 2006 and submitted to PN. Results: Fifty patients received unilateral PN. Median age was 44 years (26 - 67). All patients were previously treated with radiotherapy with or without chemotherapy and brachytherapy. At relapse, 50 presented with locally advanced disease and 7 also had metastatic disease. Twenty-four patients (49%) had improvement of uremic symptoms and/ or lumbar pain after PN and seven (14%) in Performance Status (PS). Median creatinine levels before and after PN were 6.4 and 3.7 mg/dl, respectively (p &lt; 0.05). Twenty-five patients (50%) had improvement in renal function. Until December 2006, 49 patients have died. Median overall survival after PN was 9.1 weeks (95% CI: 8.0 - 10.2). Median survival was 10 weeks (9.0 - 11.0) in 40 patients with baseline PS 1 - 3 and 1.7 weeks (0 - 3.7) in 10 patients with PS 4 (log rank, p = 0.04). Median survival in patients with and without improvement of renal function after PN was 10.7 weeks (8.6 - 12.8) and 8.1 weeks (4.8 - 11.5), respectively (log rank, p = 0.02). Twenty-nine patients (58%) died due to renal failure. Complications of PN were mainly urinary tract infection (n: 10), catheter loss (n: 9) and bleeding (n: 1). Conclusions: These data suggest that PN can be of clinical benefit for patients with recurrent cervical cancer and PS 1 to 3, but not PS 4. In fact, improvement of renal function after PN did prolong survival. Complications of PN are frequent and most patients still die in renal failure. However, our data indicate that carefully selected patients can derive benefit from this procedure. No significant financial relationships to disclose.

Post-Percutaneous Nephrolithotomy Extensive Hemorrhage: A Study of Risk Factors

We identified risk factors predicting severe bleeding due to percutaneous nephrolithotomy. Computerized data on 2,909 patients who underwent a total of 3,878 percutaneous nephrolithotomy procedures between January 1995 and December 2005 were retrospectively reviewed. Data on patients who experienced severe bleeding requiring angiographic renal embolization were compared with those on other patients using univariate and multivariate analyses. We tested the characteristics of patients, kidneys and stones together with details of the operative procedure and surgeon experience. Severe bleeding complicated a total of 39 procedures (1%) in 25 males and 14 females with a mean age of 50.7 +/- 12.6 years. Associated morbidity included shock in 6 patients and perirenal hematoma in 4. Renal angiography revealed pseudoaneurysm in 20 patients, arteriovenous fistula in 9, the 2 lesions in 8 and arterial laceration in 2. Bleeding could be controlled with superselective embolization in 36 patients (92.3%). Followup was available on 33 patients (mean 21 +/- 15 months). Renal function was stable in all patients except 3 who had a post-embolization increase in serum creatinine, of whom all had a solitary kidney and none required renal replacement therapy. Significant risk factors for severe bleeding were upper caliceal puncture, solitary kidney, staghorn stone, multiple punctures and inexperienced surgeon. Percutaneous nephrolithotomy should be performed by an experienced endourologist in patients at risk for severe bleeding, such as those with a solitary kidney or staghorn stones.

Complications of percutaneous nephrostomy in the treatment of malignant ureteral obstructions: single–centre review

The purpose of this study was to evaluate the incidence and type of complications connected with percutaneous nephrostomy (PCN) deployment by comparing two different techniques. In the last 3 years, 299 procedures of nephrostomy were performed on 201 patients (93 women, 108 men; mean age 65.7 years, range 32-102 years) at our Institute; all patients were affected by malignancy. In 44 cases (14.72%), patients presented grade IV hydronephrosis and in 255 cases (85.28%) grade II-III hydronephrosis. In 68 patients (23.07%), the procedure was carried out under emergency conditions because of the rapid worsening of renal function. All procedures were carried out in the angiography room, with the patient lying in a prone or prone-oblique position, under ultrasound and fluoroscopic guidance. Access to the pyelocalyceal system (intermediate or lower calices) was performed by using a Seldinger technique in 255/299 cases, or a one-step technique (OST) in 44 procedures when grade 4 hydronephrosis was present. Statistical analysis of results was performed using bilateral tests on proportions as well as chi2 test of independence for contingency tables. We observed no major complications. All in all, the rate of minor complications was 3.01% (9/299 cases): 8/255 (3.13%) cases with the Seldinger technique; 1/44 (2.27%) with OST. We observed 43/299 (14.4%) dislodgements: 32/255 (10.70%) with the Seldinger technique and 11/44 (3,68%) with OST. In 4/299 (1.33%), rupture of the catheter occurred, and in 2/299 (0.67%), kinking occurred (in all cases with OST). From the statistical analysis, we conclude that the examination technique modifies the percentage of complications; in particular, it significantly (p<0.05) influences complications connected with the catheter but not minor complications. In addition, the system of fixing does not affect the percentage of dislodgements. PCN is a method with a high percentage of technical success with low rate of complications thanks to combined use of sonographic and fluoroscopic guidance for the procedure. The OST technique is indicated for a highly remarkable hydronephrosis and in cases where the catheter is only placed for a short period. The Seldinger technique is carried out in patients with grades II and III hydronephrosis and if the disease is predicted to have a long duration.

Percutaneous nephrostomy and antegrade ureteral stenting: technique—indications—complications

In this review the technique, indication for and complications of percutaneous nephrostomy (PCN) and antegrade ureter stent insertion are described. In the majority of the cases PCN is performed to relieve urinary obstruction, which can be of benign or malignant nature. Another indication for PCN is for treatment of urinary fistulas. PCN can be performed under ultrasound and/or fluoroscopic guidance, with a success rate of more than 90%. The complication rate is approximately 10% for major and minor complications together and 4-5% for major complications only. Percutaneous antegrade double-J stent insertion usually is performed if retrograde ureter stenting has not been successful. However, especially in malignant obstructions, the success rate for antegrade stenting is higher than for retrograde transvesical double-J stent insertion. In the case of severe infection and bleeding after PCN JJ-stent insertion may be contraindicated so long as there is no sufficient concomitant drainage via a PCN . Lower urinary tract dysfunction should be excluded before stent placement. The complication rate is 2-4%. Consequent stent surveillance with regular stent exchange is mandatory.

Percutaneous Treatment of the Obstructive Uropathy

Purpose to analyse the technical aspects, the patient's selection criteria, and some useful tactics to reduce the complications of percutaneous nephrostomy and of other interventional procedures to temporarily treat obstructive uropathy (OU), such as double J stent insertion, dilatation of the stricture using high-pressure balloon catheters, removal of renal or ureteral calculi, fistulas treatment. Materials and Methods a fluoroscopy table and an ultrasonographic guidance are key elements. Two techniques are employed, either the Seldinger type (wire-guided catheters) or the trocar needle type. Sole contraindication: uncorrectable severe coagulopathy. Most important risk factors are: dendritic calculus, non corrected high blood pressure, obesity, small size kidney, severe scoliosis. Results high technical success of the procedure in case of dilated collecting systems (98%); it is minor without dilatation (85%). Conclusion percutaneous nephrostomy is indicated in 87% of obstructive uropathy cases. It represents the basic technique allowing other interventional procedures to treat obstructive uropathy; it should be performed by most radiologists following an adequate training with technique and materials.

Palliative percutaneous nephrostomy in 26 patients with recurrent cervical cancer

8235 Background: Cervical cancer (CC) is a public health problem in Brazil, with annual incidence rates of 20 to 40 cases/ 100.000 women. Most patients with recurrent disease have local symptoms and develop renal failure. There are no clear guidelines to predict which patients in palliative care should benefit from percutaneous nephrostomy (PN) in terms of survival and quality of life. This study aims to evaluate the outcome of patients with recurrent CC in palliative care submitted to PN and thereby identify those who can potentially benefit from this intervention. Methods: Retrospective study of 26 patients assisted in the Palliative Care Unit of INCA from January 2002 to June 2004. Results: Median age was 44 years (28 - 67). All patients were previously treated with radiotherapy with or without chemotherapy and brachytherapy. At relapse, all patients presented with locally advanced disease and 3 had metastatic disease. PN was unilateral in all patients. Sixteen patients (61%) had improvement of uremic symptoms after PN and 6 (23%) in Performance Status (PS). Median creatinine levels before and after PN were 7 and 3 mg/dl, respectively. Normalization of renal function was achieved in 10 patients (38%). Until December 2004, 24 patients have died. Median survival after PN was 61 days (95% CI: 44 - 78). Median survival was 82 days (64 - 100) in 16 patients with PS 1 - 3 and 16 days (5 - 27) in 10 patients with PS 4 (log rank p < 0.0001). Survival in patients with creatinine prior to PN lower and higher than 7 mg/dl (n: 14/12) was 74 days (48 - 100) and 48 days (0 - 106), respectively (p 0.06). In patients with creatinine after PN lower and higher than 3 mg/dl (n: 13/13) median survival was 74 days (58 - 90) and 20 days (0 - 69), respectively (p 0.02). Sixteen patients (61%) died due to renal failure, 6 (23%) from urinary sepsis and 4 (16%) from cachexia. Half of the patients had complications of PN, mainly urinary tract infection (n: 6), catheter loss (n: 6) and bleeding (n: 1). Conclusions: These data suggest that PN can be of clinical benefit for patients with recurrent CC and PS 1 to 3, offering them a chance of prolonged palliation. Improvement of renal function after PN leads to increase in survival. Complications of this procedure are frequent and most patients die in renal failure. No significant financial relationships to disclose.

Complications of percutaneous nephrostomy, percutaneous insertion of ureteral endoprosthesis, and replacement procedures.

The aim of the present study was to record and identify the frequency of complications following percutaneous nephrostomy, replacement of nephrostomy drains and percutaneous insertion of ureteral endoprostheses. During a 10-year period 341 patients were referred to our department with indications for percutaneous nephrostomy and/or percutaneous insertion of a ureteral endoprosthesis, and a total of 1036 interventional procedures were performed (nephrostomy, catheter change, stenting). There were three major complications (0.29%): two patients died during the first 30 days after the procedure, due to aggravation of their condition caused by the procedure, and one patient had retroperitoneal bleeding requiring surgery. There were 76 complications of intermediate severity (7.33%): catheter or stent displacement (n = 37, 3.57%) catheter occlusion (n = 18, 1.73%), hematuria (n = 12, 1.16%), and urinary tract infection (n = 9, 0.87%). The 55 minor complications (5.3%) comprised inflammation of the skin at the site of insertion of the percutaneous catheter. The small number of complications observed during acts of interventional uroradiology prove transcutaneous manipulations to be safe medical procedures.

07-50 Complications of percutaneous nephrostomy and nephroureterostomy catheter placement

07-50 Complications of percutaneous nephrostomy and nephroureterostomy catheter placement

Antibiotic bonded nephrostomy catheters for percutaneous nephrostomies

A prospective controlled trial of the effectiveness of a cefoxitin-bonded nephrostomy catheter was undertaken to determine the effectiveness of an antibiotic bonded catheter in decreasing the infectious complications of percutaneous nephrostomy. The study concludes that bonding of the antibiotic cefoxitin to percutaneous nephrostomy catheters did not influence the incidence of bacteriuria or urinary tract infection. In addition, observations on the overall incidence of complications from percutaneous nephrostomy are made.

Splenic abscess as a complication of percutaneous nephrostomy

We report a case of splenic abscess as a complication of percutaneous nephrostomy tube placement. The patient was a sixty-three-year-old man suffering from a recurrence of transitional cell carcinoma of the bladder after cystectomy and neobladder substitution. Computed tomography of the abdomen identified the abscess, which was drained percutaneously. The patient's condition improved dramatically, and computed tomography showed complete resolution of the abscess two weeks after drainage. Splenic abscess is fatal if untreated and should be considered in a patient in whom sepsis or left lower pulmonary effusion develops after percutaneous manipulation of the kidney.

Percutaneous nephrostomy

This article highlights the indications, techniques, and complications of percutaneous nephrostomy. The authors' comments are based on their experience with more than 200 patients.

Replacement of a dislodged nephrostomy catheter

A common complication of percutaneous nephrostomy is accidental withdrawal of the catheter. Opacification of the nephrostomy tract demonstrates an intact passage to the collecting system. First one should try to negotiate the tract with a probe under fluoroscopy. If the pelvocalyceal system cannot be entered by probing alone, a puncture is done next. The Seldinger-needle together with a 22-gauge needle and a mandrin allows to combine probing, puncture and fluoroscopy of the nephrostomy tract.

Delayed Rupture of Renal Pseudoaneurysm: Complication of Percutaneous Nephrostomy

Percutaneous nephrostomy has become an increasingly acceptable therapeutic alternative, both for high-risk patients and for patients in whom the technique offers delay on avoidance of major surgery. Lack of major morbidity or mortality, palliation of symptoms, and reduced convalescent period are major advantages [i -3]. However, the procedure is not without its risks. We report a case of traumatic renal artery pseudoaneurysm following percutaneous nephrostomy with delayed rupture into the collecting system. This case also exhibits many of the therapeutic options now available to the interventional radiologist.

Pararenal pseudocyst (urinoma) as complication of percutaneous nephrostomy

Percutaneous nephrostomy is a well-recognized procedure utilized by the radiologist both as a temporary drainage method for urinary tract obstruction and as the elective therapeutic modality in selected pathologies of the urinary tract. We report a complication not previously mentioned in the literature, urinoma formation.