Percutaneous Nephrostomy Catheter Research Articles

Does hypertension develop in children patients who underwent pyeloplasty due to unilateral ureteropelvic junction stenosis

Aims: Hypertension may develop in children with renal and cardiovascular pathologies. In our study, we aimed to investigate the prevalence of hypertension in children who underwent pyeloplasty. Methods: We retrospectively evaluated the blood pressure values measured in the postoperative period in children who were diagnosed with ureteropelvic junction stenosis and underwent pyeloplasty in the pediatric urology clinic of Ankara City Hospital between 2007 and 2020. Results: In our study, 167 patients (48 women, 123 men; mean age 3.6; 58 right, 109 left) who underwent pyeloplasty due to UPJO were evaluated. In the postoperative follow-up, hypertension was detect-ed in 5 patients (2.9%). Bilateral patients were excluded from the study. Of the 5 patients who developed hypertension, one had a pelvic ectopic kidney and one had a contralateral multicystic dysplastic kidney. All of the patients who developed hypertension had intrinsic UPJO; 3 of them were catheterized with a percutaneous nephrostomy catheter preoperatively. The mean MAG3 function was 43.3%. While the mean follow-up period of the patients was 5.6 years, it was ob-served that hypertension developed in an average of 3.5 years. In the postoperative period, there was an average increase of 1.2% in the functions of these five patients in the control scintigraphy. No patient who developed hypertension underwent a second surgical intervention. Conclusion: In cases where pyeloplasty was performed due to UPJO, blood pressure should be monitored in the postoperative period. Blood pressure should be checked, especially in advanced hydronephrotic patients with a history of percutaneous nephrostomy in the preoperative period.

Abstract No. 345 An Analysis of Biofilm Formation in Indwelling Percutaneous Nephrostomy Catheters

Abstract No. 345 An Analysis of Biofilm Formation in Indwelling Percutaneous Nephrostomy Catheters

Emergency Placed Percutaneous Nephrostomy Catheter Provides Safe and Effective Access for Future Percutaneous Nephrolithotomy Operation

Objective: It was aimed to investigate the feasibility of the percutaneous nephrostomy (PCN) catheter placed in an emergency in the future percutaneous nephrolithotomy (PNL) operation. Material and Methods: Patients who underwent PCN catheter insertion by an interventional radiologist under emergency situations prior to PNL surgery between January 2013 and December 2018 were included in the study. Demographic characteristics, indication for PCN insertion, stone characteristics, pre- and post-operative laboratory values, intra-operative data, usability/non-usability of PCN catheter for renal access, post-operative data and complications were recorded. Results: A total of 32 patients were included in the study. (PCN usable: 21, unusable: 11). Indications for catheter insertion were obstruction in 26 (81.25%) patients and urinary tract infection in 6 (18.75%) patients. Renal access was achieved in 21 (65.62%) patients by using the PCN catheter tract during PNL. The most common PCN access was used in the inferior pole. In 11 (34.37 %) patients, the PCN tract was not usable for access. In patients in whom PCN was unusable due to an unsuitable calyx for access, the most common new access site was the inferior calyx in 6 patients, the superior calyx in 3 patients and the middle calyx in 2 patients. There was no statistically significant difference between the two groups in which the PCN catheter was usable and unusable for PNL access (p>0.05), except for the mean length of hospital stay (p=0.039). Conclusions: PCN catheters inserted prior to PNL surgery can be used effectively and safely for renal access during surgery. However, in emergency cases, it is important that the PCN catheter is inserted through the appropriate calyx in patients undergoing future surgery.

Is Ultrasound-Guided Percutaneous Nephrostomy Efficacious and Safe in Pregnant Patients?: A Single Center Experience

Aim: To evaluate the safety and efficacy of ultrasound-guided percutaneous nephrostomy (PCN) placement in pregnancy. Method: Medical records of 26 pregnant patients who were inserted with a total of 27 PCN catheters between June 2020 to June 2023 were retrospectively analyzed to assess imaging findings, procedural parameters, technical success, delivery outcomes, and procedural complications. Results: At the time of placement of the PCN, the mean gestational age was 29.04±7.01 weeks (range 7 - 36 weeks). The indications for insertion of the PCN catheter included: 1) obstructing calculi (46.2%), 2) pyelonephritis (34.6%), and 3) symptomatic hydronephrosis without calculi (19.2%). Successful catheter placement was achieved in 25/27 procedures, yielding a success rate of 92.59%, and no major complications. Minor instances of transient hematuria were encountered in three cases. The mean duration of catheter retention was 72.58 days. All patients exhibited significant clinical and symptomatic improvement. Among these patients, 22 patients (84.6%) delivered their babies at full-term, 3 patients (11.5%) delivered prematurely, and 1 patient (3.8%) experienced a miscarriage. Conclusion: Ultrasound-guided PCN placement is a reliable method with high success and efficacy that can be applied during pregnancy. This procedure avoids the use of ionizing radiation, ensuring safety for both the fetus and the mother.

Percutaneous nephrostomy catheter-related infections in patients with gynaecological cancers: a multidisciplinary algorithmic approach

Percutaneous nephrostomy catheters (PCNs) are commonly utilized in patients with gynaecological cancers due to intrinsic or extrinsic urinary obstruction. Unfortunately, these foreign medical devices may be associated with several infectious complications, including: pyelonephritis, renal abscess, and bacteraemia, which may lead to further delay of life-saving cancer therapy. To evaluate the performance of our multidisciplinary algorithm for diagnosis and treatment of PCN-related infections (PCNIs) and identify risk factors for recurrent urinary device-related infections. Patients with gynaecological cancers having PCNIs were prospectively evaluated at our institution from July 2019 to September 2021. All patients were managed by our standardized algorithm and followed-up until reinfection or routine PCN exchange. Of 100 consecutive patients with PCNIs, 74 had adequate follow-up, and were analysed in three groups according to clinical outcome: reinfection with the same organism (26%), reinfection with a different organism (23%), and no reinfection (51%). Their median age was 54 years, and the most common cancers were cervical (65%), and ovarian (19%) with 53% being metastatic. The most frequently recovered micro-organisms were Pseudomonas (32%), Enterococcus (27%), and Escherichia (24%) species. The main risk factors for recurrent PCNI with the same organism were pelvic radiation therapy (P=0.032), pelvic fistulas (P=0.014), and a PCNI with the same pathogen within the previous year (P = 0.012). Our algorithm has allowed for accurate diagnosis, staging, and treatment of and identification of several key risk factors for recurrent PCNIs. These results may lead to further preventive measures for these infections.

Evaluation of risk factors, causative pathogens, and treatment in recurrent percutaneous nephrostomy catheter-related urinary tract infections in cancer patients

In cancer patients, percutaneous nephrostomy (PN) catheters can be used to relieve obstruction from chemotherapy, radiation therapy, or surgery, thereby improving kidney function and preventing further kidney damage. One of the complications of PN catheters is infections. Recurrent infections may delay chemotherapy, increase antimicrobial resistance with frequent antibiotic use, deteriorate the quality of life of patients, and increase costs. In this study, it was aimed to evaluate risk factors, causative pathogens, and treatment in recurrent PN catheter-related urinary tract infections in cancer patients. Cancer patients with PN catheter-associated urinary tract infection who were followed-up in the Infectious Diseases and Clinical Microbiology Clinic between January 1, 2012 and December 31, 2021 were included in the study. The total catheterization time, and occurrence of preinfection catheter replacement, active chemotherapy, and kidney stones were significantly higher in patients with recurrent infection when compared to the other group (P = .000, P = .000, P = .007, and P = .018, respectively). ESBL-positive Escherichia coli and ESBL-positive Klebsiella pneumoniae were most commonly isolated from the PN catheter urine cultures of patients with recurrent infections. Long-term use of the PN catheter increases the risk of urinary tract infection and sepsis. In this study, the total catheterization time, and occurrence of preinfection catheter replacement, active chemotherapy, and kidney stones were found to be risk factors for the development of recurrent PN catheter-related urinary tract infection in cancer patients. It is important to know the risk factors in recurrent PN catheter-related urinary tract infections in cancer patients, take maximum protective measures, and follow-up. Knowing both the causative profile and the resistance rates will increase the chance of success in the treatment when empirical treatment is required. It should also be noted that these patients should be included in the group of patients who need prophylaxis for urinary tract infection.

MP26-02 SURGICAL OUTCOMES OF RETROPERITONEOSCOPIC NEPHROURETERECTOMY FOR PATIENTS WITH SEVERE HYDRONEPHROSIS

You have accessJournal of UrologyCME1 Apr 2023MP26-02 SURGICAL OUTCOMES OF RETROPERITONEOSCOPIC NEPHROURETERECTOMY FOR PATIENTS WITH SEVERE HYDRONEPHROSIS Pei-Hsin Lee and Chien Hui Ou Pei-Hsin LeePei-Hsin Lee More articles by this author and Chien Hui OuChien Hui Ou More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003254.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: For upper tract urothelial carcinoma (UTUC), the severity of hydronephrosis was reported to be correlated to the advanced disease. Besides, previous studies revealed that retroperitoneal nephroureterectomy seemed to show better progression free survival than transperitoneal approach in patients with UTUC. However, when large hydronephrosis presented, the difficulty of retroperitoneal approach was elaborated. This study aimed to emphasize the efficacy of the pre-operative volume reduction procedures, which would make retroperitoneoscopic nephroureterectomy more feasible. METHODS: The 18 patients with severe hydronephrosis, who underwent retroperitoneoscopic nephroureterectomy performed by one experienced operator, from December 2005 to July 2022 in the tertiary center were retrospectively included. All the patients received the pre-operative volume reduction procedures. Primary outcomes, such as estimated blood loss, total operative time and hospitalized stay were documented. RESULTS: In our study, the three types of volume reduction procedures were implemented. In benign lesions, a percutaneous nephrostomy catheter would be inserted for drainage. For possible malignant lesions, intra-operative retrograde ureteral catheter insertion or incision at the proximal site of obstructive upper ureter was performed other than percutaneous approach, for minimizing the risk of tumor seeding. Under such managements, retroperitoneoscopic nephroureterectomy could be implemented with less blood loss (mean=25 ml, range<10 to 150), shortened operative time (mean=123.3 minutes, range 86 to 169) and lower hospital day (mean=7.2 days, range 5 to 10). Only one complication (5.6%, 1/18) was noted with hypovolemic shock. CONCLUSIONS: In the patients with severe hydronephrosis, retroperitoneoscopic nephroureterectomy might be a safe, low-risk and time-saving approach after pre-operative volume reduction of hydronephrosis. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e352 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pei-Hsin Lee More articles by this author Chien Hui Ou More articles by this author Expand All Advertisement PDF downloadLoading ...

Percutaneous Nephrostomy in Complicated Urinary Tract Infections.

BackgroundThe study aimed to determine the various indications for percutaneous nephrostomy (PCN) primarily in patients with a urinary tract infection and to determine the various complications arising in these patients due to the procedure.Materials and methodsA retrospective study of five-year data based on registers of the Department of Urology was performed. Among 716 patients, 226 inpatient data were obtained, curated, and analyzed. Indications for PCN, the periprocedural complications, the PCN's duration, details of antibiotics, risk factors for UTI, development of acute kidney injury, and renal replacement therapy were recorded.ResultsPatients were mostly female (53.1%, n=120/226). Malignancy (n=109, carcinoma cervix=68/109) and nephrolithiasis (n=70) contributed to 79.2%. Infections such as pyelonephritis, renal abscess, perinephric abscess, and genitourinary tuberculosis were identified in 47. Infectious diseases were significantly associated with younger age, female gender, diabetes, and prior pyelonephritis. PCN was placed at a median of two days after admission, and bilateral PCN was placed in 36 (15.2%) patients. Hydroureteronephrosis (probably infected) was an indication for PCN in 164/226 patients. In 33 patients with an infectious disease, PCN was performed for an obstructed urinary system. One major and two minor complications gave a rate of 0.06% for patients with infections, which was less than the accepted threshold of 4%.ConclusionsWe intended to study the utility and problems with placing a PCN catheter in patients with complicated urinary infections. We conclude that PCN is a safe and effective procedure in urinary tract infections with obstructed drainage.

Percutaneous nephrostomy for nondilated renal collecting system with ultrasound and fluoroscopic guidance: The results of a 10-year experience.

PURPOSE This study aimed to evaluate the technical success rate, complications, and radiation doses of ultrasound- and fluoroscopy-guided percutaneous nephrostomy (PCN) in patients with a nondi- lated renal collecting system. METHODS Over a 10-year period, 50 patients were referred for PCN of 60 kidneys with a nondilated renal collecting system. The patients included 22 males and 28 females with a mean age of 63.2 years (range: 35-87 years). The most common reason for PCN in these patients was postoperative ure- teral leaks and/or fistula (21/50 patients). PCN was performed under ultrasound and fluoroscopic guidance. During PCN, intravenous contrast media or diuretics were not used. Technical success rate, complications, procedure time, and radiation exposure of the procedure were retrospec- tively evaluated. RESULTS Ultrasound- and fluoroscopy-guided PCN for nondilated renal collecting system showed a suc- cess rate of 83.3% (50/60 kidneys) in the initial attempt. Four PCNs were repeated and were suc- cessful after the initial PCN failure. There was 1 major complication of bleeding that required transfusion in 1.9% (1/54) PCNs and there were minor complications of transient gross hematuria through the PCN catheter in 31.5% (17/54) PCNs. Mean duration of the procedure was 15.97 ± 7.81 min and median fluoroscopy time was 4.2 min (range: 1.2-15.3 min). Median dose area product and cumulative dose were 345.37 μGy·m2 (range: 42.57-1659.76 μGy·m2) and 46.9 mGy (range: 7.7-267.8 mGy), respectively. CONCLUSION Ultrasound- and fluoroscopy-guided PCN for nondilated renal collecting system was feasible with acceptable technical success rate, complication rate, procedure time, and radiation exposure.

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.

A Management of Ureteral Obstruction After Lichtenstein Tension-Free Hernia Repair in a Kidney Transplant Recipient: A Case Report

The number of renal transplants has been increasing in recent years. Recent literature data show that abdominal operations performed on patients who undergo renal transplant have higher morbidity and mortality. A 49-year-old man who had received a renal transplant from a living donor 19 years ago underwent Lichtenstein tension-free hernia repair. Anuria was observed after the operation. Renal ultrasound demonstrated massive hydronephrosis and an elevated serum creatinine level (4.6 mg/dL). It was thought that the ureter may have been obstructed because of the operation, and, with the patient under local anesthesia, all sutures and polypropylene mesh were removed. Urine output was still not present, so a percutaneous nephrostomy catheter was inserted to normalize renal function. The patient underwent reoperation under general anesthesia 45 hours after the first operation. It was observed that the ureter was ligated during high ligation. The ureter was released, and no additional intervention was performed. The patient was discharged 6 days later with a return to basal creatinine level and a percutaneous nephrostomy catheter. The patient was hospitalized twice for severe urinary tract infection and urosepsis within 3 months and received appropriate treatment. The patient has had an uneventful postoperative course for 18 months. Inguinal hernia repair is seen as a safe surgical procedure, but the risk of emerging urological complications is higher in patients with renal transplant. Imaging before surgery to identify the anatomy of the kidney and ureter may be useful. Delicate dissection of the extraperitoneal area during the operation will reduce surgical complications.

Pediatrik Hastalarda Ultrason Kılavuzluğunda Direkt Ponksiyon ile Perkütan Nefrostomi Kateteri Yerleştirilmesi

Objective: In this study, we aimed to evaluate the efficiency and advantages of percutaneous nephrostomy (PN) catheter insertion through the trocar method in pediatric patients with US guidance and without using contrast matter and X-ray. Material and Methods: This study included a total of 48 PN insertions in 41 patients between September 2016 and December 2019. Medical records of the patients were retrospectively assessed and anesthesia and procedure durations, complications, hospitalization and catheterization durations, and pre and post-treatment blood urea and creatinine levels were evaluated. Results: Of the PN inserted patients, 36.59% were female (n=15) and 63.41% (n=26) male with ages changing between 1 day and 2100 days (70 months). Of the nephrostomy installed kidneys, 35.42% (n=17) had grade II and 64.58% had (n=31) grade III hydronephrosis. The whole operation was successfully performed in the first session (100%). In addition to the technical success, clinical success was also observed with the decrease in serum urea, creatinine and leukocyte levels. None of our cases had major complications. During the first 24 hours of postoperative period, 25 patients (52.08%) had self-limiting mild hematuria. Conclusion: Shortened anesthesia duration, non-requirement of general anesthesia and thus minimization of many anesthesia-related complications constitute one of the advantages provided by US-guided trocar method PN. US-guided trocar method PN is a reliable, easy, low-cost and quick method in selected patients with low rates of complication and high rates of success.

DJ stent and nephrostomy drainage outcomes for upper urinary tract obstruction and determinative factors for drainage selection

Aim: To compare drainage outcomes from double J stent and percutaneous nephrostomy stent for upper urinary tract obstruction and to research factors determining the stent method to be used. Upper urinary tract obstruction may be caused by ureter and kidney stones internally or by local advanced-stage pelvic organ cancers externally and this may lead to sepsis or obstructive uropathy. It is necessary to drain the kidney immediately before definitive treatment of stone patients and prevent increased morbidity and mortality in cancer patients. Materials and Methods: A total of 213 patients with upper urinary tract obstruction and drainage using double J stent and percutaneous nephrostomy catheter were retrospectively assessed. Demographic, operative-postoperative data and predictive factors for stent selection were assessed.Results: The groups were different in terms of age and gender demographically, as well as disease duration before the procedure, comorbid diseases, causative factors, hydronephrosis degree and stone size (p 0.05). The groups were different in terms of operational data, operation time, auxiliary time, complications and definitive treatment for stones (p 0.05). Independent predictive factors for stent selection were stone size (Odds ratio:1.3), obstructive duration before the procedure (Odds ratio:1.1), causative factors (Odds ratio:38.1), and hydronephrosis degree (Odds ratio:10.5). Conclusion: For patients with long duration of obstruction and high degree of hydronephrosis, with obstruction caused by local advanced pelvic cancer and large ureter stones and with sepsis, percutaneous nephrostomy drainage should be chosen instead of double J stent drainage.

A ten-year, single institution experience with percutaneous nephrostomy during pregnancy

PurposeTo evaluate the safety and efficacy of percutaneous nephrostomy (PCN) in pregnancy. Materials and methodsPCN tubes were placed during 52 pregnancies in 49 patients from 2008 to 2018. The medical records during pregnancies were retrospectively reviewed for imaging findings, procedural parameters, outcomes of delivery, and complications. ResultsThe mean gestational age on percutaneous nephrostomy placement was 27 weeks (range, 8–36 weeks). PCN catheters were placed for the following indications: 1) flank or lower abdominal pain (42%), 2) obstructing calculi (37%), 3) pyelonephritis (20%), and 4) obstructing endometrioma (2%). Prior to PCN, retrograde ureteric stenting was performed in 17 of 49 patients (34%) and attempted but failed in 4 patients (8%). Nephrostomy drainage relieved pain completely or significantly in all 12 patients without prior ureteral stenting, but in only 4 of 10 with retrograde ureteric stents. In one patient in whom the ureteral stent had been removed, PCN relieved her flank pain. The mean number of PCN catheter exchanges was 1.6, ranging from 0 to 9, with a mean time interval of 21.3 days between exchanges. There were 29 difficult exchanges due to encrustation in 15 patients with a mean of 20.5 days between exchanges. ConclusionsPCN drainage is a safe and effective treatment for managing symptomatic hydronephrosis in pregnant patients but is less effective in treating pain when retrograde ureteral stents are in place. Rapid encrustation, seen more commonly in pregnancy, tends to recur in the same patients and requires more frequent exchanges than the general population.

Transvaginal Stent as an Effective Drainage Route for Refractory Infection of a Pelvic Tumor

The institutional review board approved this report. A 44-year-old woman underwent total hysterectomy and radiation therapy for cervical cancer. Chemotherapy was started for local recurrence of the tumor. However, the tumor enlarged and formed fistulae with the urinary bladder and rectum (Fig 1). A percutaneous nephrostomy catheter was inserted for hydronephrosis. Persisting infection in the tumor caused by the fistulae resulted in severe anal pain and high inflammatory markers, and the patient was bedridden all day. Antibiotic therapy and percutaneous drainage of the infected tumor could not control pelvic infection.

Percutaneous antegrade removal of foreign bodies in the urinary tract: a 20-year, single-center experience.

While removing urinary tract foreign bodies is mostly performed through retrograde cystoscopy, antegrade removal using interventional procedures is reported less frequently. To evaluate the safety and effectiveness of percutaneous antegrade removal of urinary tract foreign bodies. A total of 14 consecutive patients (age range 9-80 years) who percutaneous antegrade removal of urinary tract foreign bodies between January 2001 and March 2020 were reviewed. Detailed removal procedures and complications were reviewed retrospectively. Types of foreign bodies were sheared percutaneous nephrostomy (PCN) catheters (n = 5), sheared double J stents (n = 3), migrated ureteral catheters (n = 3), embolization coils (n = 2), and a 0.018-inch guide wire (n = 1). The mean and median indwelling times (range 0-306 days) of the foreign bodies were 58.3 and 1.5 days, respectively. Computed tomography (CT) scans were conducted in six patients, and the extent and nature of the foreign bodies were well-visualized on CT scans. The removal access was new PCN access (n = 8), the tract missing PCN catheter (n = 3), pre-existing PCN access (n = 2), and percutaneous dissection (n = 1). The removal success rate was 92.9% (13/14) with either a simple (n = 8) or modified (n = 4; combination of a snare and guide wire is used) snare technique or a direct forceps grasp (n = 1). The mean procedure time for successful cases was 14.2 min (range 7-25 min). Procedure-related hematoma with (n = 2) or without (n = 1) renal pelvis injury occurred in three patients, which were all self-limited within one week. Percutaneous antegrade removal is safe and effective for urinary tract foreign bodies.

Percutaneous Nephrostomy Catheter Misplacement into Inferior Vena Cava in a Patient with a Horseshoe Kidney.

Background: Percutaneous nephrostomy (PCN) is commonly indicated for upper urinary tract drainage in case of obstruction or fistula. Only a few cases of PCN catheter misplacement into the inferior vena cava (IVC) have been published. Case Presentation: We report a case of a PCN catheter misplaced into the IVC through a fistula between the urinary tract and an ipsilateral renal vein in a patient with horseshoe kidney, after bedside urgent replacement for hemorrhage and hemorrhagic shock. Conclusion: Although a nephrostomy Foley catheter can be used for adequate urinary drainage and hemostatic purposes after percutaneous nephrolithotomy, its placement should be always verified through antegrade pyelography and particular care should be used for horseshoe kidneys. In case of massive hemorrhage, after temporary closure of the PCN catheter, the cause of bleeding should be investigated with urgent angiography or contrast-enhanced CT scan and promptly treated.

Primary mucinous adenocarcinoma of the renal pelvis misdiagnosed as calculous pyonephrosis: a case report and literature review

Primary mucinous adenocarcinoma of the renal pelvis is a rare malignant disease that is difficult to diagnose preoperatively. There are still no characteristic symptoms, radiological features, or standard treatment for this tumor with only ~100 cases reported. The prognosis is poor. We report a case of a 66-year-old man who presented with a 2-month history of fever and right waist pain. He was misdiagnosed with calculous pyonephrosis and underwent percutaneous nephrostomy (PCN) at a local hospital. Gelatinous material was drained via a PCN catheter. He was then transferred to our hospital. He had elevated CEA and CA19-9. We performed an open radical nephrectomy and found polypoid, gelatinous material and stones filling the renal pelvis. He was diagnosed with primary mucinous adenocarcinoma of the renal pelvis by pathology. He refused adjuvant chemotherapy and there was no sign of recurrence after one year of follow-up. By assessing a literature review of all of the cases reported since 2000, we recommend that careful history taking, serum tumor markers, and CT scans may improve the diagnostic accuracy rates and radical nephrectomy with total ureterectomy accompanied by adjuvant therapy may improve the prognosis.

Retrospective Analysis of the Role of Antibiotic Prophylaxis in the Placement and Replacement of Percutaneous Nephrostomy Catheters in Patients with Malignant Ureteral Obstruction.

Background: Antibiotic prophylaxis is usually adopted to prevent urinary tract infection (UTI) after nephrostomy catheter placement and replacement. This prophylaxis has been little studied in cancer patients, and its efficacy is uncertain. Objective: To determine the rate of UTI associated with percutaneous nephrostomy catheters placement and replacement and associated risk factors. Methods: This retrospective study collected data from the available medical records. Catheter-related UTI was defined as any diagnosis of UTI based on clinical symptoms recorded in antibiotic prescription charts, and on the results of urine culture collected up to 7 days after percutaneous nephrostomy catheter. The associations between categorical variables were analyzed using Fisher's exact test. The risk factors for UTI were assessed using logistic regression. Results: In the univariate analyses, there was no significant difference in the rate of urinary infection between patients receiving and not receiving antibiotic prophylaxis before percutaneous nephrostomy and after replacement. Conclusion: The results of the present study suggest that the use of antibiotic prophylaxis for managing urinary tract obstruction by percutaneous nephrostomy is not recommended in cancer patients. In contrast, for catheter replacement, antibiotic prophylaxis appears to have a protective effect for UTI.

Comparison of the efficacy of percutaneous nephrostomy with central venous catheter and transurethral ureteroscopic catheterization in the emergency decompression of urinary sepsis

Objective To investigate the effects and advantages of central venous catheter for percutaneous nephrostomy and transurethral ureteral catheter insertion in the treatment of emergency ureteral calculus obstruction induced urinary sepsis. Methods From June 2013 to June 2018, a retrospective analysis about clinical data of 86 patients with the urinary sepsis treated with central venous catheter for percutaneous nephrostomy(experimental group)and 72 patients treated with transurethral ureteral catheter insertion(control group). The general condition, curative effects, complication and other information from two groups were evaluated. Results The genal clinical data between the two groups had no significant difference (P>0.05). The achievement ratio of operation between the two group had no significant difference(P>0.05). The operation time of the experimental group was shorter than control group[(16.0±4.3)min vs.(20.9±6.7)min, P 0.05) . Conclusions Both central venous catheter for percutaneous nephrostomy and transurethral ureteral catheter insertion are safe and effective for the treatment of urinary sepsis. But Percutaneous nephrostomy with central venous catheter can control infection in a shorter time, is more effective in preventing the aggravation of infection, it is better than transurethral ureteral catheter insertion, which is worth of being generalized. Key words: Ureteral Calculi; Sepsis; Central Venous Catheters; Nephrostomy, Percutaneous; Ureteroscopy