Percutaneous Nephrostomy Drainage Research Articles

Percutaneous Nephrostomy as a Procedure in the Treatment of Urinary Tract Obstruction - Experiences in the University Clinic of Urology in Skopje.

Obstructive uropathy encompasses various urinary tract obstructions, leading to changes in urine flow, kidney pressure, and impaired kidney function. Predicting renal recovery from obstructive uropathy, can be challenging and necessitates treatment, as in percutaneous nephrostomy (PNS) drainage. The choice of drainage method depends on patient-specific factors and local expertise. According to the data for the Republic of North Macedonia, in the register of the European Renal Association, in the last few years, there has been an increase in the percentage of patients with obstructive nephropathy from 7.6% to 8.9% who end up on a chronic hemodialysis program. Prompt relief from urinary tract obstruction is essential to preserve renal function and prevent complications. The aim of this study is to present our initial data analysis of recent experience in the use of nephrostomies as a method for temporary or long-term resolution of obstructive nephropathy, in terms of safety and success in preserving kidney function and reducing the number of patients on hemodialysis. This study analyzed the medical records of 24 patients with obstructive uropathy who underwent PNS placement. Data were collected for the type and degree of obstruction from the ultrasonographic examination. A pig tail nephrostomy was used, with a dilator, guided under ultrasound and controlled with contrast and fluoroscope. Obstructive nephropathy was defined as an elevation of the serum creatinine > 109 µmol/L, before the intervention. Glomerular filtration rate (GFR) was calculated according to the formula CKD epi in ml/min. Each placement of the PNS was considered as an individual procedure and the data of 38 placed nephrostomies were analyzed. We compared the laboratory analyses from the day before (D0) PNS placement and on the seventh day (D7) after PNS placement. The reduction of values for red blood cells (RBC) and hemoglobin (Hb) baseline values from D0 to D7 and the need for transfusion after the procedure were defined as a complication-bleeding. The increase in total counts of the white blood cells (WBC) and C-reactive protein (CRP) from the baseline values from D0 to D7 were defined as a complication-infection. Standard statistical methods were used for data processing. Most patients, 17 (70%), had malignant disease as the cause of obstruction. Unilateral obstruction was more common, detected in 24 (63%) of procedures, with a high degree of hydronephrosis. Obstructive nephropathy, marked by elevated serum creatinine, was observed in 23 (60%) cases before PNS placement. Complications included bleeding and infection but did not result in any fatalities. When comparing the laboratory analysis before PNS placement (D0) and seven days later (D7), a statistically significant decrease in serum creatinine (225±161 vs. 162±145, p=0.005) and an increase in GFR (47±39 vs.59±34, p= 0.005) were observed. Percutaneous nephrostomy is a safe and effective treatment option for urinary tract obstruction, especially in patients with malignancies. Continuous monitoring is essential to assess long-term complications and the longevity of PNS functionality. This procedure offers a significant benefit in preserving renal function and minimizing the need for hemodialysis in these patients.

Outcomes following Exchange and Upsizing of Malfunctioning Small-Caliber Double-J Ureteral Stents

PurposeTo determine the effectiveness of exchange and upsizing of malfunctioning small-caliber double-J (JJ) ureteral stents. Materials and MethodsThirty-one patients with malfunctioning cystoscopically placed small-caliber (6 or 7 F) JJ stents underwent transurethral (n = 28) or transrenal (n = 3) exchange and upsizing to a large-caliber (10 F) JJ stent from 2013 to 2022. Ureteral obstruction was malignant in 20 patients (65%) and benign in 11 (35%). Fifteen patients (48%) presented with persistent hydroureteronephrosis and 16 patients (52%) with worsening hydronephrosis. Acute kidney injury (AKI) was present in 19 patients (61%) at the time of stent malfunction. Therapeutic success was defined as resolution of hydronephrosis and AKI, if present. ResultsJJ stent exchange and upsizing was technically successful in 31 patients (100%) with no immediate adverse events. Therapeutic success was achieved in 27 patients (87%). During follow-up (median, 97 days; IQR, 32–205 days), 2 patients who initially achieved therapeutic success had stent malfunction, requiring conversion to percutaneous nephrostomy drainage (2/27, 7%). ConclusionsExchange and upsizing to large-caliber JJ stents can relieve urinary obstruction and resolve AKI in patients with malfunctioning small-caliber JJ stents. Large-caliber JJ stents should be considered as a salvage option for patients who wish to continue internal drainage and avoid percutaneous nephrostomy.

MP42-15 CUTANEOUS URETEROSTOMY FOLLOWING RADICAL CYSTECTOMY FOR BLADDER CANCER: A CONTEMPORARY SERIES

You have accessJournal of UrologyCME1 Apr 2023MP42-15 CUTANEOUS URETEROSTOMY FOLLOWING RADICAL CYSTECTOMY FOR BLADDER CANCER: A CONTEMPORARY SERIES Reza Nabavizadeh, Rodrigo Rodrigues Pessoa, Vignesh Packiam, Prabin Thapa, Robert Tarrell, Matthew Tollefson, R. Jeffrey Karnes, Igor Frank, Paras Shah, Vidit Sharma, and Stephen Boorjian Reza NabavizadehReza Nabavizadeh More articles by this author , Rodrigo Rodrigues PessoaRodrigo Rodrigues Pessoa More articles by this author , Vignesh PackiamVignesh Packiam More articles by this author , Prabin ThapaPrabin Thapa More articles by this author , Robert TarrellRobert Tarrell More articles by this author , Matthew TollefsonMatthew Tollefson More articles by this author , R. Jeffrey KarnesR. Jeffrey Karnes More articles by this author , Igor FrankIgor Frank More articles by this author , Paras ShahParas Shah More articles by this author , Vidit SharmaVidit Sharma More articles by this author , and Stephen BoorjianStephen Boorjian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The use of intestine for urinary diversion following radical cystectomy (RC) entails perioperative morbidity and the potential for long-term metabolic abnormalities. Limited reports exist on cutaneous ureterostomy (CU), a diversion which obviates the need for bowel interposition. Herein, we report a contemporary series of CU with RC from a tertiary referral center. METHODS: We retrospectively identified patients who underwent RC with CU for bladder cancer at Mayo Clinic between 2016-2021. Clinicopathologic and perioperative characteristics were analyzed using standard descriptive statistics. RESULTS: A total of 45 patients underwent RC with CU at our institution during this timeframe. Demographics are provided in Table 1. Median operating time was 282 minutes (IQR 214-288). Median estimated blood loss was 500mL (IQR 250-900). Surgery was done using open and robotic approach in 31 and 14 patients, respectively. Twenty-five patients had a unilateral CU (placed in the ipsilateral hemiabdomen): 8 with a solitary kidney, 2 transplant kidneys, 1 contralateral ureteral ligation due to an atrophic kidney, and 14 who underwent contralateral nephroureterectomy with RC. Of the remaining 20 patients with bilateral renal units, the ureters were either brought together using Wallace technique and a single stoma (n=11) or separately brought to each side of the hemiabdomen (n=9). Median time to flatus, regular diet, and bowel movement were 3 (IQR 3-4), 3 (IQR 3-4), and 5 days (IQR 3-7), respectively. Median length of stay was 5 days (IQR 4-7). Readmission rate within 30 days was 24% (11/45), while 51% (23/45) experienced a high-grade complication (Clavien-Dindo ≥ 3) within 30 days of surgery. All patients but one were managed with chronic indwelling stents. At a median follow-up of 12 months (IQR 0.5, 2.1), 3 patients developed stomal stenosis requiring revision and 1 required percutaneous nephrostomy drainage. Median GFR declined from 50 mL/min (IQR 30-61) at baseline to 40 (IQR 32-60) at the median follow-up of 12 months. CONCLUSIONS: In a highly comorbid, relatively elderly bladder cancer cohort undergoing RC, the use of CU was associated with expeditious surgery and postoperative recovery. CU represents an option for urinary diversion in select patients at particularly increased risk for bowel diversion with RC. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e573 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Reza Nabavizadeh More articles by this author Rodrigo Rodrigues Pessoa More articles by this author Vignesh Packiam More articles by this author Prabin Thapa More articles by this author Robert Tarrell More articles by this author Matthew Tollefson More articles by this author R. Jeffrey Karnes More articles by this author Igor Frank More articles by this author Paras Shah More articles by this author Vidit Sharma More articles by this author Stephen Boorjian More articles by this author Expand All Advertisement PDF downloadLoading ...

Rendezvous Technique: Step by Step

Introduction: The treatment of complete ureteral stenosis varies depending on the severity and location of injury but can include ureteral stent placement and surgical repair. Long-term percutaneous nephrostomy (PN) drainage is another treatment option, but it leads to deterioration of the patient's quality of life. Therefore, as an alternative to surgery similar to ureteroureterostomy, the combined antegrade and retrograde approach, the so-called rendezvous technique, is required. Materials and Methods: A 52-year-old man with a history of prior flexible ureterorenoscopy for a 12 mm ureteral stone in the ureteropelvic junction presented with insidious onset complete ureteral stenosis. A nephrostomy tube was placed, and the patient was referred to our center. An anterograde and retrograde pyelography confirmed a diagnosis of ureteropelvic stenosis thought to be secondary to prior endoscopic procedure. A combined antegrade–retrograde rendezvous dilatation of stenosis was planned. A fiber-optic and digital ureteroscope were used through the left ureter and the nephrostomy tract, respectively, and allowed a careful visual examination of the ureteral lesion. The complete stenosis did not allow the passage of a 0.035″ Terumo guidewire. Transillumination and fluoroscopy were used to direct the retrograde lasering of the tissue to create the new ureteral path with thulium fiber laser technology. Laser settings were 1 J for pulsed energy and 5 Hz for pulsed frequency with short pulse. Results: After reaching the pelvis through the retrograde access, a Double-J ureteral catheter (8F) was placed to reduce the risk of restenosis and a nephrostomy tube. Laser time was 4 minutes and 38 seconds and total energy emitted was 1.39 KJ. The nephrostomy tube was removed after 48 hours. The procedure was well tolerated and after 3 days the patient was discharged with the Double-J. A retrograde pyelography was performed 1 month later showing contrast passage. Conclusions: Combined antegrade–retrograde rendezvous dilatation offers a safe and viable alternative to high-risk surgery in patients with complete ureteropelvic stenosis. A.S. and M.C. have nothing to disclose. O.T. is a consultant for Boston Scientific, Coloplast, EMS, IPG, Quanta and Rocamed, but has no specific conflicts relevant to this study. Runtime of video: 4 mins 46 secs Consent: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.

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.

ENDOSCOPIC MANAGEMENT OF URETEROVAGINAL FISTULA AND RETRIEVAL OF INTRARENAL FRAGMENTED GUIDEWIRE BY URETEROSCOPY: A CASE REPORT AND LITERATURE REVIEW.

Gynaecological surgery remains the most common cause of ureterovaginal stulas. Most common surgery responsible for a ureteric injury is total abdominal hysterectomy. Rare reports of foreign bodies in the renal pelvis and kidney have been made. Majority of times, FBs are brought on by external factors (violence or accidents) or endourological procedures. We report a patient with fragment of PTFE guidewire embedded in the renal parenchyma and pelvicalyceal system following attempted Ultrasound guided percutaneous nephrostomy drainage (PCND) for ureterovaginal stula, and our successful minimally invasive management with Ureteroscopy of renal foreign body and ureterovaginal stula.

A Single-Center Review of Clinical Profile, Prognostic Factors, and Outcomes of Emphysematous Pyelonephritis ─ A Retrospective Study

Background: Emphysematous pyelonephritis (EPN) is an uncommon life-threatening condition characterized by the production of gases within the renal parenchyma and perirenal space. We aimed to study the clinical features, radiological classification, prognostic factors of EPN, and outcome among the various radiological classes of EPN. Methods: All the patients who were admitted to the urology ward of our Institute were included and the study period was for the last 5 years. It was a retrospective study and the collection of file records were done from the medical record section department of our Institute. Results: Overall 20 cases were diagnosed to have emphysematous pyelonephritis. There were 12 females and 8 males and the majority of the patients were from (40-50) age groups. Eighteen cases had type 2 diabetes mellitus and two patients had upper ureteric calculus. 16 cases had unilateral involvement, 3 had bilateral involvement and one patient had solitary kidney with EPN. 12 cases were classified as having class 1 or 2 diseases and eight cases had class 3 and 4 diseases. The most common clinical presentations were flank pain (95%) and fever (85%). The most common organism cultured was Escherichia Coli (E. coli) (70%). Most of the cases were managed by percutaneous nephrostomy drainage (PCN) of the collecting system with medical management. Shock at admission (p=0.009), serum creatinine &gt;5.0 mg/dl (p= 0.031) and DIC (p= 0.045) were independent poor prognostic factors. Conclusions: Early control of blood sugar with vigorous hydration and appropriate intravenous extended-spectrum antibiotic should be the initial treatment of choice. Early percutaneous nephrostomy should be tried even in advanced stages. Shock, DIC and Serum creatinine &gt;5mg/dl on admission are independent predictors of poor outcome

Clinical Outcomes following Percutaneous Urinary Diversion for Hemorrhagic Cystitis

Hemorrhagic cystitis (HC) can lead to severe morbidity in treatment-refractory cases. Percutaneous nephrostomy (PCN) drainage was first described in 1993 as a safe, nonoperative procedure to achieve supravesical urinary diversion and treat severe HC. Despite its early success, subsequent studies in the adult population have been limited. This retrospective case series describes long-term outcomes following PCN placement in 24 patients with refractory HC. The overall technical success of the procedure was 100%. Seventeen of 24 (71%) patients experienced resolution of hematuria. The median time for hematuria resolution after the procedure was 12 days (interquartile range, 7–28 days). Postprocedural HC severity grade significantly decreased from a median Grade 3 to Grade 1 (P < .01). The complications included catheter obstruction, dislodgement, and associated urinary tract infections occurring at rates of 1.0, 1.6, and 1.7 per 1,000 catheter days, respectively. This study of PCN placement demonstrated and further confirmed the effectiveness of urinary diversion in treating refractory HC.

Retrograde intrarenal surgery for impacted upper ureteral stone in a patient with advanced lumbar scoliosis and lower-extremity development defect: a case report

BackgroundToday, retrograde intrarenal surgery is the most preferred and very successful treatment method for upper ureteral stones that do not spontaneously pass and/or do not benefit from extracorporeal wave lithotripsy. However, perioperative complications are more common in retrograde intrarenal surgery if the stone in the ureter is impacted. Moreover, urosepsis and renal dysfunction are detected more frequently in patients with impacted stones. Impacted stones, which are a risky stone group even in patients with normal vertebral anatomy, are a more challenging situation in patients with advanced vertebral scoliosis. It is difficult to achieve an operating position in these patients. In addition, the ureteral tracing is altered, curved, and tortuous, making it more difficult for the endoscope to advance through the ureter.Case presentationIn this case report, we present a 23-year-old Caucasian male patient with right concavity and severe scoliosis, lower-extremity developmental disorder, and urosepsis. To treat the urosepsis picture, first percutaneous nephrostomy drainage was provided and the urine was sterilized with appropriate antibiotics according to the culture/antibiogram. Then, we performed ureterolithotripsy with a flexureterorenoscope. Finally, we see that flexible ureterorenoscopic lithotripsy to the upper ureteral stone with impacted stones, which is a very challenging operation even in patients with normal vertebrae, could be successfully performed in our patient with advanced scoliosis deformity.ConclusionHigh stone-free and low complication rates can be obtained with flexible ureterorenoscopic retrograde intrarenal surgery in medium-sized impacted upper ureteral stones in patients with advanced scoliosis.

Percutaneous nephrostomy in Ureteropelvic junction obstruction with poorly functioning kidney: Is it still pertinent in adults?

To determine the pertinence of percutaneous nephrostomy drainage in adult patients of primary ureteropelvic junction obstruction with poorly functioning kidneys (<20% split renal function). Clinical records of all patients with primary ureteropelvic junction obstruction with poorly functioning kidneys who underwent percutaneous nephrostomy drainage in our institute between February 2015 and January 2020 were retrospectively reviewed. The patients were divided into 4 groups according to their split renal function obtained from the Tc-99m ethylenedicysteine diuretic renogram. Group I consisted of all patients having split renal function ≤5%, group II with split renal function 6-10%, groupIII with split renal function 11-15%, and finally group IV with split renal function 16-20%. Those patients inwhom split renal function was improved by >10% and had daily percutaneous nephrostomy output >400 mL, underwent pyeloplasty and the rest underwent nephrectomy. Seventy-two patients were studied, out of which 5 were in group I, 20 in groups II and III each, and27 in group IV. The mean age of presentation was 34.4 ± 14 years. The split renal function improvement of>10% was seen in 55 patients (76.4%) after percutaneous nephrostomy drainage (P < .05). Pyeloplasty wasdone in 40 patients (55.6%) and nephrectomy was done in 32 patients (44.4%). In conclusion, we recommend the use of a Tc-99m ethylenedicysteine scan for estimation of split renal function during the initial presentation in every patient followed by reconstructive surgery if split renal function is above 15% and nephrectomy if it is below 5%. The trial of percutaneous nephrostomy is pertinent if split renal function is between 6% and 15%.

A Single-Center Review of Clinical Profile, Prognostic Factors, and Outcomes of Emphysematous Pyelonephritis ─ A Retrospective Study

Background: Emphysematous pyelonephritis (EPN) is an uncommon life-threatening condition characterized by the production of gases within the renal parenchyma and perirenal space. We aimed to study the clinical features, radiological classification, prognostic factors of EPN, and outcome among the various radiological classes of EPN. Methods: All the patients who were admitted to the urology ward of our Institute were included and the study period was for the last 5 years. It was a retrospective study and the collection of file records were done from the medical record section department of our Institute. Results: Overall 20 cases were diagnosed to have emphysematous pyelonephritis. There were 12 females and 8 males and the majority of the patients were from (40-50) age groups. Eighteen cases had type 2 diabetes mellitus and two patients had upper ureteric calculus. 16 cases had unilateral involvement, 3 had bilateral involvement and one patient had solitary kidney with EPN. 12 cases were classified as having class 1 or 2 diseases and eight cases had class 3 and 4 diseases. The most common clinical presentations were flank pain (95%) and fever (85%). The most common organism cultured was Escherichia Coli (E. coli) (70%). Most of the cases were managed by percutaneous nephrostomy drainage (PCN) of the collecting system with medical management. Shock at admission (p=0.009), serum creatinine &gt;5.0 mg/dl (p= 0.031) and DIC (p= 0.045) were independent poor prognostic factors. Conclusions: Early control of blood sugar with vigorous hydration and appropriate intravenous extended-spectrum antibiotic should be the initial treatment of choice. Early percutaneous nephrostomy should be tried even in advanced stages. Shock, DIC and Serum creatinine &gt;5mg/dl on admission are independent predictors of poor outcome.

Retrieval of intrarenal coiled and ruptured guidewire by retrograde intrarenal surgery: A case report and literature review

BackgroundForeign bodies in the kidney have rarely been reported. However, they can be a clinical problem for urologists. We report on a patient with a residual segment of guidewire coating embedded in the renal parenchyma following computed tomography (CT)-guided percutaneous nephrostomy drainage (PCND), and our successful minimally invasive management with retrograde intrarenal surgery (RIRS).Case presentationA 40-year-old female with urosepsis due to a right upper ureteral stone with hydronephrosis received emergent CT-guided PCND and subsequent ureteroscopic lithotripsy, double J stent insertion, and percutaneous catheter removal. Follow-up radiography showed a coiled object within the upper pole parenchyma of the right kidney, which might be the remnant of a guidewire used during the PCND procedure. Flexible ureteroscopy (fURS) was performed. Under fluoroscopy, the foreign body was localized, the renal parenchyma was incised with laser, and the foreign body was retrieved using a stone basket.ConclusionAlthough guidewire breakage is uncommon, clinicians should keep it in mind during interventional procedures. Several methods can be used to eradicate foreign objects from the urinary tract, and the first choice should always be the least invasive one. RIRS with fURS is considered as a safe, efficient, and minimally invasive option for the extraction of foreign bodies from the kidney. To the best of our knowledge, this is the first comprehensive case report detailing the removal of a foreign object by RIRS in the English literature.

V09-10 URETERAL SIDE-TO-SIDE ANASTOMOSIS FOR TRANSECTING INJURY OF COMPLETELY DUPLICATED COLLECTING SYSTEM

You have accessJournal of UrologyUpper Tract Reconstruction (V09)1 Sep 2021V09-10 URETERAL SIDE-TO-SIDE ANASTOMOSIS FOR TRANSECTING INJURY OF COMPLETELY DUPLICATED COLLECTING SYSTEM Randall Lee, Aeen Asghar, David Strauss, Michael Metro, and Daniel Eun Randall LeeRandall Lee More articles by this author , Aeen AsgharAeen Asghar More articles by this author , David StraussDavid Strauss More articles by this author , Michael MetroMichael Metro More articles by this author , and Daniel EunDaniel Eun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002052.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Iatrogenic injuries commonly occur at the distal ureter. The gold standard for distal ureteral injury is ureteroneocystotomy, however new techniques such as side-to-side (StS) anastomosis have demonstrated safe and comparable outcomes. In a duplicated collecting system, two ipsilateral ureters may drain the kidney into the bladder independently or as a single common ureter which may complicate preoperative planning for ureteral reconstruction. Currently limited literature exists regarding iatrogenic distal ureteral injuries to duplicated collecting systems. METHODS: 51 year old female with a history of left robot assisted hysterectomy which was complicated by flank pain post operatively. Imaging work up revealed a duplicated left collecting system with left hydronephrosis concerning for ureteral injury and obstruction. After failed ureteral stent placement patient underwent percutaneous nephrostomy drainage of both left renal moieties. Patient was evaluated and scheduled for a robotic ureterolysis and reconstruction, and ultimately underwent a robotic assisted side-to-side anastomosis and ureteroneocystotomy as described in our video. RESULTS: Total console time was 241 minutes with an estimated blood loss of 150 mL. There were no intraoperative complications. Patient was discharged with ureteral stent and foley on post operative day one. On follow up, patient with no clinical or radiographic evidence of left ureteral obstruction. CONCLUSIONS: We demonstrate that robot-assisted StS ureteral anastomosis with an intravesical non-refluxing ureteroneocystotomy in a duplicated collecting system is a safe and effective option. This technique allows maximal preservation of ureteral perfusion and reimplantation of one ureter. ICG helps facilitate ureteral dissection and assess ureteral blood supply intraoperatively to aid in successful reconstruction. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e690-e690 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Randall Lee More articles by this author Aeen Asghar More articles by this author David Strauss More articles by this author Michael Metro More articles by this author Daniel Eun More articles by this author Expand All Advertisement Loading ...

Transperitoneal laparoscopic ureteropyeloplasty of retrocaval ureter: Single surgeon experience and review of literature.

Retrocaval ureter (RCU) is a rare congenital abnormality, secondary to anomalous development of inferior vena cava (IVC) presenting as ipsilateral obstruction needing surgical intervention. The aim of this article is to present surgical techniques and outcome of transperitoneal laparoscopic ureteropyeloplasty in patients with RCU treated by a single surgeon at a tertiary care center and with review of literature. We conducted a retrospective, institutional review board approved chart review of patients who underwent transperitoneal laparoscopic ureteropyeloplasty for RCU at our unit between January 2010 and December 2020. A total of 10 patients were identified. Preoperative evaluation involved a computed tomography-intravenous urography in addition to the conventional evaluation. All the patients underwent dismembered transperitoneal laparoscopic ureteropyeloplasty over a Double J stent. Data analyzed included the demographic profile, operative time difficulty if any, postoperative, intraoperative complications and functional outcome. All cases were completed laparoscopically and no open conversion was required. Average operating time was 96.6minutes± 8.16. Average blood loss was 71 ± 14.49 mL with an analgesia requirement of 115 ± 33.74 mg. One patient developed postoperative urinary leak and responded to percutaneous nephrostomy drainage. Patients were followed up for 3 to 12 months with a serial ultrasound and a follow-up diethylene-triamine-penta-acetic acid renal scan at 3months to rule out any anastomotic site obstruction. Transperitoneal laparoscopic ureteropyeloplasty for RCU was associated with minimal morbidity and good outcomes.

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.

Outcome of conservative and minimally invasive management in emphysematous pyelonephritis.

Context:Developing countries.Introduction:Emphysematous pyelonephritis (EPN) is a urologic emergency characterized by acute necrotizing infection with the presence of gas in the kidney, perinephric space, and/or urinary collecting system.Materials and Methods:It is a retrospective study of inpatients at the Department of Urology, RG Kar Medical College and Hospital, Kolkata, which includes twenty patients diagnosed as EPN between September of 2018 and May of 2020.Results:Patients were classified as per computed tomography (CT) severity grading proposed by Huang and Tseng. In our study, medical management with antibiotics was effective in 10% of patients. Twenty percent of patients were treated with medical management and internal ureteral stenting. Fifty percent of the patients were treated with medical management and percutaneous nephrostomy (PCN). Ten percent needed PCN drainage in addition to Double J (DJ) stenting. Ten percent needed percutaneous drainage of perinephric abscess along with PCN. Ten percent of patients were treated with open drainage in addition to DJ stenting and percutaneous drainage of perinephric collection as they failed to respond to minimally invasive intervention alone, with repeat ultrasonography showing persistent collection. There was no mortality in the group.Conclusion:EPN patients are mostly moribund with multiple comorbidities. It is vital to comprehend the management with a prompt CT imaging. Proactive hemodynamic stabilization, antimicrobial therapy, complementing it with DJ stenting and/or PCN in cases not responding to antibiotics alone, can treat most of the patients with this pathology.

Outcome of Percutaneous Nephrostomy in Children With Ureteropelvic Junction Obstruction

Introduction and objectives: Congenital ureteropelvic junction obstruction (UPJO) is the most common cause of hydronephrosis. Management protocols are based on the presence of symptoms and when the patient is asymptomatic the function of the affected kidney determines the line of treatment. Percutaneous nephrostomy (PCN) became a widely accepted procedure in children in the 1990s. The aim of the study was to evaluate the results of performing percutaneous nephrostomy (PCN) in all patients with UPJO and split renal function (SRF) of less than 10% in the affected kidney, because the management of such cases is still under debate. Methods:This prospective clinical trial was carried out at Dhaka Medical College Hospital from January 2014 to December 2016. Eighteen consecutive patients who underwent PCN for the treatment of unilateral UPJO were evaluated prospectively. In these children, ultrasonography was used for puncture and catheter insertion. Local anesthesia with sedation or general anesthesia was used for puncture. Pig tail catheters were employed. The PCN remained in situ for at least 4 weeks, during which patients received low-dose cephalosporin prophylaxis. Repeat renography was done after 4 weeks. When there was no significant improvement in split renal function (10% or greater) and PCN drainage (greater than 200 ml per day) then nephrectomies were performed otherwise pyeloplasties were performed. The patients were followed up after pyeloplasty with renograms at 3 months and 6 months post operatively. Results: All the patients had severe hydronephrosis during diagnosis and 14 patients with unilateral UPJO were improved after PCN drainage and underwent pyeloplasty. The rest four patients that did not show improvement in the SRF and total volume of urine output underwent nephrectomy. In the patients with unilateral UPJO who improved after PCN drainage, the SRF was increased to 26.4% ±8.6% (mean± SD) after four weeks and pyeloplasty was performed. At three and six months follow-up, SRF value was 29.2% ±8.5% and 30.8.2% ±8.8% respectively. Conclusion: Before planning of nephrectomy in poorly functioning kidneys (SRF &lt; 10%) due to congenital UPJO, PCN drainage should be done to asses improvement of renal function. Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.61-64

Efficacy and Safety of Semi-rigid Ureteroscopic Lithotripsy (URS) for Proximal Ureteral Stone ≥10 mm

To evaluate the efficacy and safety of the semi-rigid URS with pneumatic lithotripsy for the treatment of large (>10 mm) proximal ureteral calculi. Cohort study. Section of Urology, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan, from January 2010 to December 2018. All patients with single, radio-opaque unilateral proximal ureteral stones >10 mm were included in the study. Patients with urosepsis, pregnancy, solitary kidney, and indwelling JJ stent or prior percutaneous nephrostomy drainage were excluded. Patients without any visualisation of stone on abdominal X-Ray done at 4 weeks of the procedure were labelled as stone-free. One hundred and three cases with stones >10 mm and fulfilling the selection criteria were included. The mean age was 40.83 + 14.92 years. The mean stones size was 13.33 + 4.64 mm. The mean procedure time was 41.50 + 15.60 minutes. Indwelling JJ stents were placed in 49 (47.6 %) cases. The stone-free rate was 83.5% at four weeks with calculated efficiency quotient (EQ) of 0.72, using a standard equation. The overall complication rate was 27% with the majority being minor (Clavian-Dindo grade 1). Only one patient had urosepsis (MCG IV). Ancillary procedures were performed in 17 (16.5%) cases, most commonly the extracorporeal shock wave lithotripsy (ESWL) in 14 (13.5%) cases, followed by the secondary URS in 3 (2.9%) cases. Semi-rigid URS is an effective and safe procedure for the large proximal ureteral stones, with limited access to flexible instruments. Key Words: Ureteroscopy, Semi-rigid, Stone, Proximal, Clearance, Safety.

Does Diversion in Poorly Functioning Obstructed Kidneys in Adults Favors Reconstructive Surgeries Over Ablative Procedures? A Prospective Study.

ObjectiveIn obstructed poorly functioning kidneys, management depends on the recovery potential of the kidney. Some kidneys have good recovery capability and diversion may unfold the real condition of the kidney. This study evaluated whether pre-operative drainage for six weeks results in improvement of renal function in unilateral obstructed poorly functioning kidney with split renal function (SRF) less than 20%.MethodsThis was a prospective interventional study conducted between March 2013 and December 2015. All patients between 15 and 65 years, with unilaterally obstructed kidney with SRF ≤20% underwent percutaneous nephrostomy (PCN) drainage for six weeks. Patients having post-drainage SRF of ≥15% and per day urine output from PCN > 400 ml were considered for the reconstructive procedure. Nephrectomy was performed in cases with SRF <15% after considering patient preferences.ResultsTwelve of 17 patients had improvement in SRF; four had no change while one had a decrease in SRF after drainage. The mean improvement in glomerular filtration rate (GFR) and SRF was 1.4 ml/min and 3%, respectively (P = 0.08). Three out of seven patients with SRF of ≥15% showed an improvement of 5% or more while none of the patients with SRF <15% had such an improvement. Eight patients had final SRF <15% and underwent nephrectomy. Factors such as pre-existing SRF, duration of symptoms, kidney size, transverse pelvic diameter, 24-hour urinary output, and etiology for obstruction were not significant in predicting functional improvement.ConclusionDiversion and decompression of poorly functioning kidneys do not result in a significant functional improvement in obstructed kidneys with SRF <15%.

Minimally invasive management of acute ureteral obstruction and severe infection caused by upper urinary tract calculi.

PURPOSETo evaluate therapeutic efficacy of two minimally invasive surgical methods in managing acute ureteral obstruction and severe infection caused by upper urinary tract calculi (UUTC).PATIENTS AND METHODSData of 47 patients diagnosed with acute upper urinary tract obstruction and severe infection caused by ureteral calculus using X-ray CT between September 2014 and January 2019 were retrospectively analyzed. All patients were treated with immediate renal drainage and, after infection and ureteral obstruction were relieved, UUTC removal. Renal drainage was performed by ultrasound-guided percutaneous nephrostomy and retrograde ureteral catheterization was performed using cystoscopy. Kidney and ureteral stones were removed; renal function and the urinary tract were examined by X-ray during follow-up.RESULTSPercutaneous nephrostomy was performed in 29 patients in a critical condition including intolerance to surgery, high-grade hydronephrosis, or failure of retrograde ureteric stent placement. In other 18 patients diagnosed with small stones (≤10 mm) and low-grade hydronephrosis, indwelling double-J ureteral stents were temporally installed by a cystoscope. Acute infection and ureteral obstruction were relieved; white blood cell counts returned to normal values within 3 to 7 days after drainage in all patients. In the second-stage treatment, percutaneous nephrolithotomy (PCNL), ureteroscopic lithotripsy, extracorporeal shock wave lithotripsy and nephrectomy were performed in 24, 10, 8 and 5 patients, respectively. No patients developed severe complication after stone removal surgery. All patients were followed up for 3 months to 4.5 years. Renal function was significantly recovered; 17/29 (59%) patients with elevated serum creatinine returned to normal and serum creatinine in 12/29 (41%) patients improved significantly after drainage, with a pre-operation level of 285±169μM vs 203±91μM post-operation (P = 0.014). Five patients were lost during follow-up.CONCLUSIONThis study demonstrated an optimal approach for relieving upper urinary tract obstruction and acute infection in which percutaneous nephrostomy drainage is preferred for patients with severe pyonephrosis, large stones (>10 mm) with high-grade hydronephrosis, steinstrasse, or failure in retrograde ureteric stent placement, while retrograde ureteral catheterization using cystoscopy is suitable for patients diagnosed with small stones (≤10 mm) and low-grade hydronephrosis.