Removal Of Nephrostomy Tube Research Articles

1943 FACTORS AFFECTING POST NEPHROSTOMY TUBE REMOVAL LEAK AFTER PERCUTANEOUS NEPHROLITHOTOMY

(age 14-84, mean 54) had B-PCNL. Stone burden per renal unit averaged 2.8 cm (0.7-7.0) and 2.9 cm (0.7-9.0), respectively. Overall complication rate was higher for B-PCNL (53.2% vs 30.8%, p 0.013). Rates of Grade I and Grade II complications trended toward being higher in the B-PCNL group (Table 1). Low-grade complications (Grade I and II combined) occurred more often in the B-PCNL group (p 0.011, not shown in table); the most common low-grade complication was febrile urinary tract infection. There were equivalently low rates of Grade III complications, which included three urinary tract decompressions for febrile obstruction, two chest tubes for hydrothorax, and one negative exploratory laparotomy for pneumatosis intestinalis. No Grade IV or V complications occurred. CONCLUSIONS: B-PCNL carries a higher complication rate than U-PCNL, though the majority of complications seen after either procedure are low-grade. B-PCNL is an acceptably safe procedure and should remain standard of care for large bilateral stone burdens treated at experienced centers. However, patients should be counseled that low-grade complication rates are higher than U-PCNL.

Percutaneous nephrolithotomy: keeping the bridge for one night

We read the retrospective study comparing the outcomes of nephrostomy-free percutaneous nephrolithotomy (PCNL) with early nephrostomy tube removal (after 1 day) with great interest [1]. Only 55 highly selected cases who underwent non-complicated PCNL through a single tract were identified to receive either no nephrostomy tube or an 22-Fr nephrostomy tube. They stated that in the tubeless group, all patients were administered with a ureteral catheter for drainage of the kidney. Preoperatively, the groups were similar. Postoperatively, a large proportion of patients in each group were stone-free. Post-operative events such as hematuria and renal colic were significantly more in tubeless group. Mean dose of post-operative analgesia, mean hemoglobin deficit and hospital days were comparable for both groups. The study has shown that 1-day nephrostomy technique after PCNL is significantly better post-operative course and it is comparable to nephrostomyfree technique in analgesic requirements and hospital stay. The nephrostomy tube also provides a bridge for second look nephroscopy in patients with residual stones. With the intent of reducing post-operative discomfort and pain, hospital stay, and cost, tubeless PCNL procedure has gained popularity in recent years [2]. Traditionally, the placement of a nephrostomy tube at the conclusion of PCNL is considered the standard of care. However, the need for nephrostomy tube placement has been questioned by numerous authors. In two recent metaanalysis with 90 studies, it was shown that tubeless PCNL was a safe and effective procedure for treatment of large renal stones in selected patients with shorter hospital stay, less analgesic requirement, lower urine leakage and without increased complications [3, 4]. On the other hand, appropriate patients should be selected for tubeless PCNL. We believe that, this procedure will only be acceptable when safety has not been sacrificed. For this reason, we use criteria such as minimal bleeding, no residual stone and intact collecting system when choosing the patients in our center. Renal colic was observed in four patients after the operation in tubeless group in this study. It is not surprising to see that observation of ureteral stents may cause mucosal irritation. We believe that the major advantage for patients undergoing tubeless PCNL was the absence of stent-related flank pain and dysuria. We agree with the authors comment that the possible limitation of the tubeless PCNL is that it precludes second look PCNL for residual stones. However, when a secondary percutaneous procedure for removal of residual stones is planned, the pre-existing tract may not provide good access to reach the stone. In most cases, generating a new access tract may be necessary. Alternatively, residual calculi can be safely managed by SWL or retrograde intrarenal surgery in this group of patients.

Percutaneous nephrolithotomy: keeping the bridge for one night

This study was conducted to compare nephrostomy-free percutaneous nephrolithotomy (PCNL) with early nephrostomy tube removal (after 1 day). A prospective study started from January 2008 through December 2009 and included patients who underwent non-complicated PCNL through a single tract without intra-operative residual stones. Nephrostomy-free technique was performed during 2008 (nephrostomy-free group). During 2009, a nephrostomy tube was placed for 1 day (1-day nephrostomy group). Both groups were compared for post-operative events, dose of analgesia, hemoglobin deficit and hospital stay. The study included 55 patients (27 in nephrostomy-free group and 28 in 1-day nephrostomy group). There were no statistically significant differences between patients, renal and stone characteristics of both groups. Post-operative events were significantly more in nephrostomy-free group (26 vs. 14.3%, p = 0.039). They include hematuria in three (11.1%) of nephrostomy-free patients and one (3.6%) of 1-day nephrostomy patient, severe renal colic in four patients of nephrostomy-free group (14.8%), and temporary urinary leakage via the nephrostomy site in three patients of 1-day nephrostomy group (10.7%). Mean dose of post-operative analgesia, mean hemoglobin deficit and hospital days were comparable for both groups (p = 0.946, 0.541, 0.807, respectively). A second look PCNL was performed through the already present tract to retrieve residual stones in two patients with nephrostomy. In conclusion, 1-day nephrostomy technique after PCNL showed significantly better post-operative course. It was comparable to nephrostomy-free technique in analgesic requirements and hospital stay. The nephrostomy tube provided a bridge for second look nephroscopy.

Transsplenic Percutaneous Nephrolithotomy

Percutaneous nephrolithotomy (PNL) is the treatment of choice for patients with large or complex renal calculi. Although injuries to intra-abdominal organs are rare during PNL, splenic injuries have been reported. The management of a splenic injury after PNL is not well defined; therefore, we performed a study to define a management strategy for such an event. A retrospective, multi-institutional study was performed to identify all cases of splenic injury that occurred during PNL. All procedures were performed as a single-stage operation, with percutaneous access obtained in the operating room by the urologist. A review of patient records and imaging was conducted to identify treatment strategies and outcomes. Three patients were identified as having undergone a transsplenic PNL. All puncture sites were upper pole, supracostal access of the left kidney. All cases of injury were identified after the procedure, with two stable patients' injuries identified on postoperative CT scan, and a third patient presenting with significant bleeding at removal of the nephrostomy tube. The spleen-preserving, conservative management strategy was successful, because no patients needed exploratory surgery. Splenic injury is a rare complication sustained most commonly during supracostal, upper-pole access to the left renal unit. When patients are hemodynamically stable, this complication can be conservatively managed, with prolonged nephrostomy drainage and observation in a monitored setting before and after nephrostomy tube removal.

A Randomized Controlled Trial of Nephrostomy Placement Versus Tubeless Percutaneous Nephrolithotomy

We established whether totally tubeless percutaneous nephrolithotomy with no nephrostomy or ureteral stent is a safe management technique. Patients were randomized to have a nephrostomy placed (group 1 control) or none (group 2 treatment). A total of 25 patients were randomized to each group. Cases were considered uncomplicated and suitable for randomization if there was no significant bleeding or residual stone load, the pelvicaliceal system was intact and there was no evidence of a residual ureteral stone. The primary outcome measure was length of stay, and secondary outcomes were analgesic requirements and postoperative complications such as bleeding, infection or ureteral obstruction. Hospital readmission rates and stone clearance rates were also recorded. Mean stone size was 21.6 vs 17.5 mm. There were no transfusions in either group. Hemoglobin change was 2.03 vs 1.18 gm/dl and mean creatinine increase was 0.029 vs -0.111 mg/dl. There were no differences in hemorrhage, infection and serum parameters. There were no readmissions in either group. Mean length of stay was 3.4 vs 2.3 days (p <0.05). This trial demonstrates that percutaneous nephrolithotomy without nephrostomy or stent is a safe and well tolerated procedure in selected patients. Length of stay was reduced with no major complications in either group. We believe that totally tubeless percutaneous nephrolithotomy may be considered an accepted standard of care for selected cases and it is possible to reserve placement of a nephrostomy tube or internal ureteral stent for specific indications.

Prevention and treatment of complications following percutaneous nephrolithotomy

The aim of this article is to identify classification and grading systems of percutaneous nephrolithotomy-related complications and evidence for the prevention and treatment of these complications. A total complication rate of up to 83% following percutaneous nephrolithotomy was recognized. These complications were mostly clinically insignificant including minor bleeding or fever. The frequency of major complications was 0.9-4.7% for septicemia, 0.6-1.4% for renal hemorrhage requiring intervention, 2.3-3.1% for pleural injury and 0.2-0.8% for colonic injury. The significance of grading perioperative complications according to their severity, emphasizing the need for a unique and broadly accepted classification system, which could be helpful for monitoring and reporting outcomes emerged from the current review. The modified Clavien system has recently been used for this purpose. Proper patient selection, preoperative imaging for planning the operation, adequate antibiotic prophylaxis and therapy, manipulation of the collecting system only under fluoroscopic or endoscopic control, use of a continuous flow system, use of normal saline as irrigant fluid, judicious stone fragmentation and finally fluoroscopic monitoring of nephrostomy tube insertion and removal are necessary to prevent percutaneous nephrolithotomy complications. Appropriate treatment has been sufficiently described in the literature. Currently, a high index of suspicion and prompt recognition and institution of appropriate treatment of percutaneous nephrolithotomy-related complications is fundamental to limit morbidity.

Inguinal Herniation of a Transplant Ureter: Rare Cause of Obstructive Uropathy

We present a rare case of late renal allograft failure from ureteral obstruction resulting from inguinal herniation. A 72-year-old man presented with an elevated creatinine and hydroureteronephrosis of a transplanted kidney on ultrasound. Noncontrast computed tomography demonstrated an inguinal hernia containing ureter, and a nephrostomy tube was placed. The hernia and ureter were temporarily reduced during antegrade stent insertion. Creatinine normalized and we performed inguinal herniorrhaphy with polypropylene mesh. The ureter was not reimplanted. Renal function remained stable after nephrostomy tube removal. Simple herniorrhaphy without ureteral reimplantation may fix the case of ureteral obstruction from inguinal herniation.

F-18 FDG PET Visualization of Urinary Leak After Nephrostomy Tube Removal

We present multiple coronal views of a whole-body F-18 FDG PET scan. Transmission images were first acquired and were followed by emission images 1 hour after intravenous administration of 14.9 mCi of the radiopharmaceutical. The study was requested for evaluation of a CT-noted left upper lung nodule in a 45-year-old man admitted for nephrostomy tube removal after percutaneous nephrolithotomy. The scan showed mild FDG uptake in the pulmonary nodule. Abnormal distribution of the radiopharmaceutical was noted posterolateral to the right kidney in addition to the physiological renal excretion. Also presented are abdominal CT images revealing the location of the right nephrostomy tube before removal.

Renal obstruction caused by herniation of renal pelvis and ureteropelvic junction through superior lumbar triangle hernia (Grynfeltt hernia)

a p F a t superior lumbar triangle hernia (Grynfeltt hernia) is an uncommon type of abdominal all herniation. It is bounded by the 12th rib, the nternal oblique abdominal muscle, and the sacropinalis muscle.1,2 A 76-year-old woman with history of abdominal ortic aneurysm presented to the emergency deartment with complaints of nausea, vomiting, ight flank pain, and acute renal insufficiency. oncontrast computed tomography of the abdoen and pelvis with three-dimensional recontruction (Fig. 1) revealed herniation of retroperioneal fat, the right renal pelvis, and ureteropelvic unction through a lumbar hernia bounded by the 2th rib, internal oblique abdominal muscle, and acrospinalis muscle, with resultant hydronephrois. She had no history of previous surgery in the rea, and no scars were present. Management included placement of percutaneus nephrostomy tube, antegrade nephrostograhy (Fig. 2), with antegrade internal ureteral stent lacement, allowing reduction of the ureteropelvic unction (Fig. 3), normalization of renal function, nd subsequent nephrostomy tube removal. The perative repair consisted of reduction of the heria contents, including retroperitoneal fat and ight renal pelvis, and repair of the abdominal deect with nonabsorbable mesh.

Immediate Closure of Nephrostomy Tube Wounds Using a Tissue Adhesive: A Novel Approach following Percutaneous Endourological Procedures

We assessed the feasibility of immediate sealing of nephrostomy tube wounds after percutaneous surgery using a tissue adhesive. The study represents a prospective series of 27 consecutive percutaneous procedures. After nephrostographic exclusion of infrarenal urinary obstruction the nephrostomy tubes were removed and the wound edges were glued together using 2-octyl cyanoacrylate. The wound was covered by gauze to assess the efficiency of sealing and the patients were followed clinically. Another consecutive series of 20 patients who had been treated during 6 months before the current study were used for comparison. The nephrostomy wound in this group was dressed and left to close spontaneously. A total of 27 percutaneous procedures were performed in 25 patients with a median age of 51 years (range 9 to 77). There were 26 cases of percutaneous nephrolithotomy for an average stone burden of 32.6 mm. (range 16 to 70) and 1 pediatric case of percutaneous antegrade balloon dilation of ureteral stricture related to Cohen reimplantation. Median size of the nephrostomy tubes was 16Fr (range 12Fr to 24Fr) and they were maintained a median of 4 days (range 1 to 16) postoperatively. Urinary leakage ceased immediately after tissue adhesive application in all cases. One patient in whom renal colic developed secondary to edema of the ureteral orifice underwent temporary stenting in retrograde fashion. There were no additional complications at a median followup of 5 months (range 3 to 7). The study group had a significantly shorter hospital stay than the wound dressing group (p <0.001). Wound sealing following nephrostomy tube removal using 2-octyl cyanoacrylate appears to be a safe, simple and efficient method for immediate abolishment of urinary leakage. This novel approach avoids patient and medical personnel inconvenience, permitting early release from the hospital without physical and social limitations related to persistent wound urinary discharge.

Partial Extraction of Double‐J Stent during Nephrostomy Tube Removal and its Prevention

Partial Extraction of Double‐J Stent during Nephrostomy Tube Removal and its Prevention

Perirenal hematoma following catheter removal an unusual complication of percutaneous nephrostomy

A case of perirenal hematoma following nephrostomy tube removal is presented. Computed tomography was useful in defining the extent of the hematoma. The patient was managed conservatively with eventual resolution of the hematoma.

Complications of percutaneous nephrolithotomy.

Of 582 patients who underwent percutaneous nephrolithotomy, 4% had complications. The most common complications were fever (23%) and bleeding necessitating transfusion (12%). Extravasation was seen in 7% of patients and transient ureteral obstruction in 6%. Other complications included pneumothorax or hydrothorax, pneumonia/atelectasis, paralytic ileus, nephrostomy-tube dislodgment or urine drainage from the flank lasting more than 1 week, significant infection, urinoma formation, renal pelvic laceration, ureteral avulsion, ureteropelvic or ureteral stricture, bowel injury, or escape of stone fragments into the retroperitoneum. Seven patients (1%) required immediate surgery: four to repair renal pelvic lacerations, one to repair a ureteral avulsion, and two to control bleeding after nephrostomy-tube removal when embolization failed. Four patients required delayed surgery for ureteral or ureteropelvic junction strictures, which may have been caused by a tissue reaction to the stones rather than by the procedure itself. There were two deaths--one from respiratory failure in a patient with severe interstitial pulmonary fibrosis and chronic renal failure and the other from myocardial infarction in an obese diabetic patient with hypertension.