Emergency Percutaneous Nephrostomy Research Articles

Predictive factors for stone management timing after emergency percutaneous nephrostomy drainage in patients with infection and hydronephrosis secondary to ureteral calculi.

This study examined the interval between stone management and emergency percutaneous nephrostomy drainage in patients with infection and hydronephrosis secondary to ureteral calculi. A retrospective chart review was conducted for 88 patients treated for 94 stones enrolled in this study from 2005 to 2020. The mean age was 60.7 ± 15.2years (range: 2-87years). The average stone size was 1.51 ± 0.8cm (range: 0.4-4cm). The most common location was the upper ureter (n = 71, 75.5%), followed by the lower (n = 17, 18.1%) and middle (n = 6, 6.4%) ureter. The mean interval between percutaneous nephrostomy drainage and secondary stone management was 8.17 ± 11.6days (range: 1-76days). Most patients underwent operations within 1week (n = 72, 81.8%). Abnormal white blood cell counts were found in most patients (58, 65.9%). Tachycardia was detected in 40 (45.5%) patients. Only 11 (12.5%) patients had fever upon emergency department arrival. Severe shock was reported in 6 (6.8%) patients. More than half of all patients (45, 51.1%) experienced acute kidney injury, and 37 (42%) patients had elevated C-reactive protein levels. Most patients (69, 73.4%) received ureteroscopic lithotripsy as stone management. Mean arterial pressure (MAP) was the only significant parameter (p = 0.016) affecting the operation interval, with MAP < 60mmHg associated with longer operation intervals (16.2days). The timing of stone surgery depends on clinician discretion and patient recovery.

A case of giant hydronéphrosis on obstructive ureteral lithiasis

Adult giant hydronephrosis is a rare clinical entity. His clinical diagnosis is not obvious. We report a case of a 42-year-old man, who was admitted for a large intra-abdominal mass, painless, evolving for about 8 months. The clinical examination showed a very distended abdomen. The abdominal CT confirms the diagnosis of left giant hydronephrosis on ureteral lithiasis. Surgical treatment consisted of an emergency percutaneous nephrostomy followed by a secondary left nephrectomy. The evolution was favourable and the aftermath were simple.

Emergency percutaneous nephrostomy versus emergency percutaneous nephrolithotomy in patients with sepsis associated with large uretero-pelvic junction stone impaction: a randomized controlled trial.

ABSTRACTIntroduction A randomized trial was conducted prospectively to evaluate the efficacy, related complications, and convalescence of emergency percutaneous nephrolithotomy compared to percutaneous nephrostomy for decompression of the collecting system in cases of sepsis associated with large uretero-pelvic junction stone impaction.Materials and Methods The inclusion criteria included a WBC count of 10.000/mm3 or more and/or a temperature of 38°C or higher. Besides, all enrolled patients should maintain stable hemodynamic status and proper organ perfusions. A total of 113 patients with large, obstructive uretero-pelvic junction stones and clinical signs of sepsis completed the study protocol. Of those, 56 patients were placed in the emergency percutaneous nephrostomy group, while the other 57 patients were part of the percutaneous nephrolithotomy group. The primary end point was the time until normalization of white blood cells (WBC) at a count of 10.000/mm3 or less, and a temperature of 37.4°C or lower. The secondary end points included the comparison of analgesic consumption, length of stay, and related complications. Statistical analysis was performed using SPSS® version 14.0.1. The Mann-Whitney U test, chi-square test, and Fisher’s exact test were used as appropriate.Results The length of hospital stays (in days) was 10.09±3.43 for the emergency percutaneous nephrostomy group and 8.18±2.72 for the percutaneous nephrolithotomy group. This set of data noted a significant difference between groups. There was no difference between groups in regard to white blood cell count (in mm3), time to normalization of white blood cell count (in days), body temperature (in ºC), time to normalization of body temperature (in days), C-reactive proteins (in mg/dL), time taken for C-reactive proteins to decrease over 25% (in days), procalcitonin (in ng/mL), or complication rates.Conclusions This study confirms that emergency percutaneous nephrolithotomy may be as safe as early percutaneous nephrolithotomy in a selected low risk patients with sepsis-associated large, obstructive stone.

Role of emergency ultrasound screening in the management of acute pyelonephritis in emergency department: A large observational study from a tertiary care center of South India

Background: Role of emergency ultrasound screening (EUS) in the evaluation of all patients with clinically suspected acute pyelonephritis (APN) in the emergency department (ED) remains unclear. The aim of the study was to describe the frequency of abnormal EUS findings in APN presenting to ED and ascertain the laboratory abnormalities associated with significant abnormal findings to identify the subgroup of patients who will benefit from EUS in ED. Methodology: In this retrospective study, electronic medical records were searched to identify all adult patients who underwent EUS screening from ED for initial clinical diagnosis of APN over 1 year. The EUS findings were categorized into normal, major abnormalities (hydronephrosis, renal abscess, and emphysematous pyelonephritis), and mild abnormalities (cysts, calculi, and renal edema). Results: A total of 1218 patients with initial clinically diagnosed APN underwent EUS. Nearly 49% had a normal EUS while 51% had at least one major or minor abnormality. The frequency of hydroureteronephrosis, renal calculi emphysematous changes, and renal abscess was 19.1%, 8.9%, 2.1%, and 1.9%, respectively. Only 72 (5.9%) patients required emergency percutaneous nephrostomy or drainage of an abscess. Among these patients, EUS was able to identify a major abnormality in sixty (83.3%) patients. Male gender, presence of diabetes mellitus, peripheral white blood cell (WBC) count >10,000 cells/cumm, serum creatinine >1.4 mg%, and urine WBC count >100 cells/hpf were found to independently predict the presence of an abnormality on an EUS. Conclusion: A large proportion of APN patients have only normal or minor abnormalities and do not need additional screening and intervention.

La nefrostomía percutánea en el carcinoma cérvico-uterino avanzado con uropatía obstructiva

BackgroundTo describe our experience with emergency percutaneous nephrostomy in patients with advanced cervical cancer accompanied by obstructive uropathy. Material and methodsA descriptive study was conducted that evaluated 12 patients diagnosed with advanced cervical cancer, obstructive uropathy, and kidney function damage. ResultsTwo study groups were formed: group A (with previous cancer-specific treatment) and group B (without previous cancer-specific treatment). Eight patients (66.7%) presented with bilateral ureteral obstruction and only 4 (33.3%) with unilateral obstruction. A total of 41.7% had obstructive anuria, with elevated levels of serum creatinine, and 33.3%, in addition to presenting with anuria, had associated symptoms of sepsis and fluid and electrolyte imbalance. A significant decrease was more remarkable when bilateral percutaneous nephrostomy was carried out over a 7-day period. The procedure caused minor complications in 75% of the patients, the most frequent of which was catheter obstruction. ConclusionsPercutaneous nephrostomy was more effective as a temporary measure for saving kidney function than retrograde catheterization or surgical diversion.

UP-01.104 Emergency Percutaneous Nephrostomy in Supine Position by Urologist Under Local Anesthesia

UP-01.104 Emergency Percutaneous Nephrostomy in Supine Position by Urologist Under Local Anesthesia

Emergency percutaneous nephrostomy in supine-oblique position without cushion

The most frequent cause of obstructive uropathy with sepsis is ureteral lithiasis. Normally, two positions are used for placement of percutaneous nephrostomy: prone position and supine position. We describe a supine-oblique position without cushion consists of placing the patient in lateral position while we lean him until his back is in a 45° angle with the operating table to perform the percutaneous nephrostomy. Our experience since 2005 with 42 procedures is good, with 100% of success and without important complications.

Emergency Percutaneous Nephrostomy

The primary indication for the urgent percutaneous nephrostomy is to relieve an obstructed and infected renal collecting system (pyonephrosis). Percutaneous nephrostomy catheter placement is a safe procedure with a high technical success rate. This article will discuss all aspects regarding the emergent placement of nephrostomy catheters, including the indications, techniques, results, and complications. Differences between emergent and nonemergent placement of percutaneous nephrostomy catheters will also be addressed.

LAPAROSCOPIC ANDERSON-HYNES DISMEMBERED PYELOPLASTY IN CHILDREN

Purpose The feasibility and results of laparoscopic Anderson-Hynes dismembered pyeloplasty in children were evaluated. Materials and Methods All laparoscopic Anderson-Hynes pyeloplasties performed by the author were retrospectively reviewed. A total of 18 children 3 months to 15 years old (mean age 17 months) with proved ureteropelvic junction obstruction underwent laparoscopic Anderson-Hynes dismembered pyeloplasty between August 1994 and June 1998. Of the 18 pyeloplasties 15 were performed in children who had not undergone previous upper tract surgery, and 3 had undergone previous upper tract surgery, including laparoscopic pyeloplasty in 2 and emergency percutaneous nephrostomy drainage of pyonephrosis 6 weeks earlier in 1. All operations were performed via a transperitoneal route. Results Postoperative evaluation is complete in 16 patients and pending in 2. Of the 16 patients 14 (87%) have no demonstrable evidence of obstruction. Two patients with persistent obstruction underwent repeat laparoscopic pyeloplasty. There was no conversion to open surgery. Mean operative time was 89 minutes. In 1 patient trocar hematoma resolved with bed rest. In another case the stent was misplaced with its distal end reaching the lower ureter, and was removed via ureteroscopy 6 weeks postoperatively. There was no other operation related morbidity. Conclusions Laparoscopic Anderson-Hynes pyeloplasty represents an attractive alternative to conventional open pyeloplasty. It is technically challenging but with practice it may be completed in the same time as conventional open pyeloplasty. It offers results approaching those of conventional dismembered pyeloplasty.

Emergency Percutaneous Nephrostomy: Technical Success Based on Level of Operator Experience

The outcomes of emergency percutaneous nephrostomy procedures performed by operators with different levels of experience were analyzed. A prospective study of 160 patients undergoing 169 emergency percutaneous nephrostomies was conducted. Three categories of operator experience were compared based on the number of percutaneous nephrostomies performed each year (level 1 = more than 20, level 2 = 10-20, or level 3 = less than 10). The level 1 operators (mean fluoroscopy time, 2 minutes; mean procedure time, 25 minutes) achieved success in 141 of 142 cases (99%) and failed in one case (1%), which was repeated successfully the next day. The level 2 operators (mean fluoroscopy time, 6 minutes; mean procedure time, 35 minutes) achieved initial success in all of 15 cases (100%), but three cases (20%) were repeated the next day because of catheter migration or malposition. Level 3 operators (mean fluoroscopy time, 10 minutes; mean procedure time, 42 minutes) were successful in 10 of 12 cases (83%), but in four cases (33%) the procedure had to be repeated. The experience of the operators played little role in the initial success rate of the procedure after they had performed 10 or more per year. However, the level of experience did influence the number of procedures that needed to be repeated, the prevalence of minor complications, and the mean fluoroscopy and procedure time.

Emergency Percutaneous Nephrostomy: Results and Complications

Percutaneous nephrostomy is a well-established standardized procedure in the management of patients with various urologic problems. The goal of this study was to evaluate the effectiveness and safety of percutaneous nephrostomy in an emergency setting. Emergency percutaneous nephrostomy was performed in 160 patients with ages ranging from 2 to 89 years (mean, 52 years). Access to the kidney was planned and achieved with C-arm fluoroscopic guidance. The initial technical success rate was 98%. Overall complication rate was 34%; 6% were major and 28% were minor. Major procedure-related complications, including sepsis, occurred in 6% of patients. Hematuria requiring transfusion was noted in 2.4% of patients. Minor complications included catheter displacement or malposition (4.8%), pelvic perforation (4.3%), paralytic ileus (2.4%), pneumonia/atelectasis (1.8%), and pleural effusion (1.2%). High-risk patients included those with diabetes, hypertension, and obesity. No deaths or significant morbidity resulted from any complication. Emergency percutaneous nephrostomy under fluoroscopic guidance is a simple, safe, and effective procedure and should be offered in all suitably equipped radiology departments.