Percutaneous Nephrostomy Tube Research Articles

Characteristics of Bacterial Colonization and Urinary Tract Infection after Indwelling of Double-J ureteral Stent and Percutaneous Nephrostomy Tube.

Introduction:Infections associated with catheter in the upper urinary tract (CUUT), which include the double-J stent and the percutaneous nephrostomy (PCN) tube, get particularly infected in patients with specific risk factors for developing an infection.Methods:A retrospective observational study was carried out by compiling data from the hospital information system of a tertiary care center from 2019 to 2021 to evaluate infections in patients with catheter in the upper urinary tract.Result:A total of 200 pus samples of double-J stent (96 pus samples) and PCN tube (104 pus samples) were included in our study. Among patients with nephrostomy tube, the most frequently isolated microorganisms were Escherichia coli, followed by Pseudomonas spp. In those with a double-J stent, Pseudomonas aeruginosa, followed by E. coli were the most commonly isolated microorganisms. We found 55.72% of cases of Enterobacteriaceae-producing carbapenemases in patients with a percutaneous catheter. 66.07% of Enterobacteriaceae in patients with double-J and nephrostomy stents are extended-spectrum beta-lactamase-producing bacteria. The percentage of cultures with multiple-drug resistance (MDR) microorganisms was 38.54% in patients with double-J stents and 37.75% in nephrostomy tubes. The presence of prior urinary tract infection (P = 0.010), presence of urinary catheter before admission (P = 0.005), increased time with single urinary catheter in-situ (P < 0.001), and increased length of hospital stay (P = 0.036) were risk factors for isolation of MDR microorganisms.Conclusion:Pseudomonas spp. and Pseudomonas aeruginosa are commonly infecting both the CUUT. E. coli infections are more commonly infecting the nephrostomy tubes. MDR microorganisms are frequent, mainly in patients with prior urinary tract infection, presence of urinary catheter before admission, and prolonged use of a single catheter.

Robot-Assisted Laparoscopic Ureterocalicostomy in the Setting of Ureteropelvic Junction Obstruction: A Multi-Institutional Cohort.

Recurrent ureteropelvic junction obstruction (UPJO) after failed pyeloplasty is a complex surgical dilemma. The robot-assisted laparoscopic ureterocalicostomy (RALUC) is a potential surgical approach, but widespread adoption is limited due to the perceived technical challenge of the procedure. We present a multi-institutional pediatric cohort undergoing RALUC for recurrent or complex UPJO, and hypothesize that the procedure is reproducible, safe and efficacious. A 3-center multi-institutional collaboration was initiated and medical records of children undergoing RALUC between 2012 and 2020 were retrospectively reviewed. The details on baseline demographics, perioperative characteristics and postoperative outcomes were aggregated. During the study period 24 patients, 7 (29%) females and 17 (71%) males, were identified. Of the patients 21 (86%) had a history of previous pyeloplasty prior to RALUC, of whom 5 (24%) had 2 prior failed ipsilateral pyeloplasties. The reason for performing RALUC was short ureter in 3 (13%), intrarenal pelvis in 5 (21%) and extensive scarring at the ureteropelvic junction locus in 16 (67%) patients. The median age of patients at time of surgery was 5.1 years (IQR: 1.9, 14.7). Of the patients 9 (38%) had percutaneous nephrostomy prior to surgery; if percutaneous nephrostomy tubes were placed for relief of obstruction, an antegrade contrast study was done postoperatively to confirm resolution of obstruction. No 30-day Clavien-Dindo Grade III-V complications were noted. During the median followup of 16.1 months (IQR: 6, 47.5), 22 (92%) had improved symptoms and hydronephrosis with no further intervention; 2 (8%) patients underwent endoscopic interventions after RALUC and both ultimately underwent nephrectomy. This multi-institutional cohort demonstrates that RALUC is a safe and efficacious salvage option for failed pyeloplasty or complex anatomy with an acceptable success profile, especially in cases of extensive scarring at the UPJO or an intrarenal pelvis.

Obstructive oligo-anuria revealing pelvic gynecological cancers, analysis of a series of 102 cases

IntroductionObstructive Anuria (OA) constitutes a diagnostic and therapeutic emergency involving the vital prognosis of the patient requiring an emergency and multidisciplinary care. The etiologies are multiple and the pelvic gynecological cancers represent one of the main causes of OA. ObjectivesDescribing the epidemiological, clinical, paraclinical, etiological, therapeutic and progressive aspects of obstructive anuria of the gynecological origin, in the urology department in the University Hospital Center. Materials and methodsThis is a descriptive and retrospective study spread over a period of 4 years (2016–2019) including all the patients admitted for management of OA secondary to the pelvic gynecological cancers. Results102 patients were included in the study whose the mean age was 60 years old (36–84). The main etiologies were cervical cancer (93%), followed by endometrial cancer (5%) and ovarian cancer (2%). The mean time to consultation was 4.5 days (1–8). The main circumstances of discovery were anuria (67%), oligoanuria (21.5%), low back pain (17%) and hematuria (9%). Clinical examination found an altered general condition (Performans Status> 2) in 37.5% of the patients and an advanced local state in 96% of the patients. The means of serum creatinine and blood urea were 122 mg/l and 2.4 g/l respectively. The hemodialysis (HD) was indicated in 29.5% of patients with life-threatening hyperkalemia (Kalemia> 6.4meq/l) with cardiac distress (20.5%), hydro-sodium overload (6%) and metabolic acidosis (3%). The ultrasound-guided percutaneous nephrostomy was the main method of diversion (92%) followed by the placement of the double J stent (8%). The outcome was favorable in the majority of patients with normalization of the kidney function (88%) while 7% of cases kept chronic kidney disease. The main complication was an obstruction syndrome (41%), followed by infections of the percutaneous nephrostomy tubes (13%) and venous thrombosis of the lower limbs (3%). In addition, the mortality was estimated at 5%. ConclusionThe obstructive anuria constitutes a medico-surgical emergency involving the patient's vital prognosis. Our study notes the frequent association between the pelvic gynecological tumors and the obstructive anuria, which can be explained by the advanced stage of these tumors. This work underlines the fundamental interest of early diagnosis of these tumors to enable the prevention of the OA.

Long-Term Management of Post-Transplant Ureteral Stricture with Surgical Reconstruction: A Case Series and Literature Review

Introduction: Ureteral stricture is the most common complication after kidney transplant and is largely responsible for graft dysfunction. Surgical intervention is the definitive treatment if conservative management with stenting and percutaneous nephrostomy tube placement fails and has been shown to have comparable long-term survival rates and limited post-operative complications. Methods: This is a single-center retrospective study following seven patients who received a kidney or a kidney and pancreas transplant between August 2012 and January 2021. These patients underwent surgical ureteral reconstruction after failed conservative management of a ureteral stricture. The reconstruction procedures performed were native ureter to transplanted kidney ureteropyelostomy, native bladder to transplanted renal pelvis vesicopyelostomy, non-transecting side-to-side ureteroneocystostomy, and a Boari flap creation. Data collected from electronic medical records included recipient age, gender, delayed post-transplant complications, ureteral reconstruction technique, and post-reconstruction outcomes. Renal ultrasound (RUS), renogram, nephrostogram, serum creatinine (Cr), and graft biopsy were used to assess for severity of hydronephrosis, ureteral stricture, and graft dysfunction. Serum Cr and RUS were used to assess renal function after the ureteral reconstruction. Results: Six out of seven cases resulted in reduced or resolved hydronephrosis and preserved graft function without future nephrostomy or ureteral stenting. One case required immediate revision due to persistent obstruction, and this patient had concomitant rejection leading to intrarenal stricture requiring ureterocalycostomy. Conclusions: Formal ureteral reconstruction is the definitive treatment for many cases of ureteral strictures after transplant. The surgical technique chosen for these procedures must consider the physical and functional state of the bladder, ureter, and kidney. Our series outlines multiple surgical approaches that should be considered early in the management of post-transplant ureteral strictures to limit graft dysfunction.

Which objective emergency department parameters leads to expedited intervention in patients with acute urinary tract calculi.

Objectives:To retrospectively determine which objective measurements had an increased likelihood of requiring immediate surgical intervention in patients presenting to the emergency department (ED) with acute ureteral calculi.Materials and methods:Employing our institution's electronic medical record system, we conducted a retrospective cohort study of 4366 patients who presented to the ED with an acute ureteral calculus over an 8-year period. Data consisting of relevant demographic information, vital signs, laboratory parameters, and interventional history was obtained and analyzed.Results:This study consisted of 4366 patients presenting to the ED with acute ureteral calculi, of whom 312 (7%) required a procedure prior to being discharged. Of these 312 patients, 290 (6.6%) underwent cystoscopy with ureteral stent placement and 22 (0.5%) were sent to interventional radiology for percutaneous nephrostomy tube placement. Patients who tested positive for nitrites in their urine had a relative risk of 3.48 of receiving intervention when compared to the nitrite negative group.Conclusions:Through this retrospective cohort study, we were able to find what objective measurements were associated with an increased need for immediate surgical intervention in patients who presented to the ED with acute ureteral calculi. With this data, urologists can be better equipped to identify the patients that present in the emergency setting that will require urgent intervention.

Ultrasound guided direct puncture percutaneous nephrostomy: a single tertiary centre observational study

Background: Percutaneous nephrostomy (PCN) is indicated to drain the upper urinary tract collecting system in cases of obstruction. Objective of our study is to evaluate the safety and efficacy of Ultrasound guided direct puncture PCN in our populations.Methods: This observational study was conducted from May 2020 to April 2021in department of urology and renal transplant. The total 65 patients with upper urinary tract obstruction requiring PCN were enrolled. All parameters were recorded and statistical analysis was performed using the Statistical package for the social sciences (SPSS 16.0) for windows.Results: In our study Ca Cervix with ureteric infiltration (35%) was the most common indication for PCN tube placement. Majority of patients (83%) had Grade IV and Grade III hydroneprosis. Single attempt for tube placement was sufficient most of the time in (86% cases). Direct Puncture PCN tube placement was successful in 62 (95.4%) cases. The mean duration of procedure was 12.4 minutes. Loin pain was the most common procedure related complication observed in 58 patients. There was no evidence of visceral injury, no need of blood transfusion in post procedural duration in our study.Conclusions: USG guided direct puncture PCN technique is simple, low cost, less time consuming, less chance of loss of tract and effective procedure for drainage of urine in case of upper urinary tract obstruction. We recommended this procedure in grade III and IV hydronephrosis and this procedure suitable for developing countries like India because of procedure related low cost.

Percutaneous transrenal ureteral plug embolization: is there a need for tissue adhesives?

We aimed to evaluate the feasibility, effectiveness and safety of ureteral embolization exclusively using Amplatzer Vascular Plugs (AVPs) in the management of ureteral leakages. A retrospective analysis of 7 patients with ureteral leakages and fistulas having undergone transrenal ureteral embolization with AVPs was performed. In all cases, AVPs were deployed via a preexisting percutaneous transrenal nephrostomy tube. Technical and clinical success as well as complications were evaluated. During a 4-year study period, 11 ureters in 7 patients were embolized using AVPs. In one case additional coil embolization was conducted. Technical success in terms of sufficient occlusion of the treated ureter was achieved in 100% of the procedures. Median size of used plugs was 16.0 mm (range, 12-18 mm). Number of deployed AVPs ranged between one and three. Median procedural time was 24.00 minutes, and a median dose area product of 58.92 Gy•cm2 was documented. No procedure-related complications occurred. During a median follow-up period of 7 weeks, recurrence of the treated leak could not be observed. Ureteric plug embolization in patients with ureteral leakages or fistulas is a feasible, effective, and safe technique, even without the addition of tissue adhesives. However, due to the often limited prognosis and life expectancy of the affected patients, long-term experiences are still lacking.

SIGNIFICANCE OF IgG4 IN IDIOPATHIC RETROPERITONEAL FIBROSIS

(Objective)Retroperitoneal fibrosis is largely divided into the idiopathic and secondary types. Some idiopathic cases include IgG4-related diseases, which are often similar to malignant diseases, such as lymphoma and sarcoma. The diagnostic criteria for IgG4-related disease are used and pathologic examination is necessary for a definitive diagnosis of IgG4-related retroperitoneal fibrosis. The first choice of treatment for IgG4-related retroperitoneal fibrosis is steroid administration, but no consensus has been established regarding its dose and tapering schedule. We investigated the significance of IgG4 in diagnosis and treatment of idiopathic retroperitoneal fibrosis. (Patients and methods)We examined 14 cases diagnosed as idiopathic retroperitoneal fibrosis between April 2013 and March 2019. Serum IgG4 was measured at the time of diagnosis in 13 cases, and changes over time in serum IgG4 before and after the induction of steroid therapy were measured in 6 cases. Computed tomography-guided biopsy was performed on 4 cases. (Results)Of all cases, 1 patient was diagnosed as IgG4-related retroperitoneal fibrosis and 5 patients were classified as possible group. Ten patients were administered steroid therapy. Percutaneous nephrostomy tube was placed in 3 patients and was removed in 2 of these patients after steroid therapy. The serum high levels of IgG4 were confirmed in all 4 patients who were classified into the possible group and who were treated with steroids. (Conclusion)Although histologic examination is necessary for the diagnosis of retroperitoneal fibrosis, tissue collection by open or laparoscopic surgery is highly invasive. CT-guided biopsy may be useful in high-risk cases, such as elderly patients on anticoagulation. After excluding other diseases in high-risk cases, response to empiric steroid therapy may be diagnostic. In the possible group, changes in serum IgG4 levels may reflect the disease condition and might be useful in determining the maintenance dose of steroids.

Minimally invasive management of massive giant hydronephrosis in tertiary care centre Northern Sri Lanka: A case report.

Introduction & importanceGiant hydronephrosis (GH) is defined as a kidney containing greater than 1000 ml of urine in its collecting system. It is a rarely presented condition in an adult. Common aetiology for GH is due to congenital ureteropelvic junction obstruction. We present a case of a late presentation of GH was being managed by a minimally invasive laparoscopic technique.Case presentationA 63-year-old Sri Lankan male presented with worsening of generalized abdominal swelling with vague abdominal symptoms for a six-month duration, found to have a GH of the left kidney on USS. The Contrast-enhanced computerized tomography (CECT) scan confirmed the diagnosis with 12l of fluid and possible ureteropelvic junction obstruction (UPJO). CT did not show any excretion of the left kidney. Hydronephrosis was drained one day before the surgery by a percutaneous nephrostomy tube. Laparoscopic transperitoneal nephrectomy was performed. The patient had a smooth and fast recovery.DiscussionA neglected congenital UPJO can present with GH in adults. It causes vague abdominal symptoms like abdominal distension, dyspepsia, and fatigue. CECT will give the diagnosis and identify the aetiology of GH. Non-functional GH kidneys can be treated with nephrectomy by open or laparoscopic surgical technique. Laparoscopic nephrectomy shoes less blood loss during surgery, less postoperative pain and early recovery after surgery. However, in GH, surgeons need the experience to overcome the challenges like adhesions and working in a small space.ConclusionsThe percutaneous nephrostomy decompression followed by laparoscopic transperitoneal nephrectomy is feasible for a massive GH.

MP53-09 INDIA INK TATTOOING OF URETEROENTERIC ANASTOMOSES

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (MP53)1 Sep 2021MP53-09 INDIA INK TATTOOING OF URETEROENTERIC ANASTOMOSES Mei Tuong, and Tracey Krupski Mei TuongMei Tuong More articles by this author , and Tracey KrupskiTracey Krupski More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002083.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Upper tract access is necessary to treat diseases in the ureter or kidney after urinary diversion. Access through the insensate conduit is more cost-effective versus percutaneous kidney access. However, endoscopic ureteroenteric anastomoses (UEA) identification can be difficult. We injected India Ink (ink) into bowel mucosa near UEA during ileal conduit diversion (IC) to determine the safety and feasibility of ink tattooing and ability to facilitate retrograde upper tract access. METHODS: After IRB approval, patients undergoing IC were prospectively randomized to receive ink or normal saline (NS) injections, a control group to assess safety of ink. Injections were placed 1 cm from UEA in a triangular configuration with a 19-gauge needle. Follow-up minimized cost and radiation exposure to assess patency and location of UEA. 1-month loopogram assessed for ureteral reflux (UR). If there was any absent UR, looposcopy was performed to assess for occult UEA stricture (UEAS). Ability to visualize UEA and/or ink tattooing was recorded at time of looposcopy. RESULTS: 42 renal units (21 patients) undergoing IC were randomized to ink (20 renal units) or NS (22 renal units). Overall median age was 65 (IQR 60, 73) years with ink patients being older (72 vs 61 years old, p=0.04). Ink patients also had a higher Charlson Comorbidity Index (5 vs 2, p=0.01). Loopogram and looposcopy protocol data are shown in Figure 1. 20 renal units had no UR on loopogram (12/16 ink vs 8/20 NS). Of patients who returned for looposcopy, 14 non-UR renal units were assessed (6/12 ink vs 8/8 NS). Visualization of UEA was achieved in 6 (100%) and 4 (50%) in ink versus NS patients, respectively (p=0.26). Follow up of the cohort revealed a higher than expected UEAS rate in the ink group (N=3, 30%) compared to NS (N=1, 9%). The ink vs NS cohorts underwent 6 vs 1 surgeries respectively for UEAS (p=0.28). 2 ink and 1 NS patients were managed with either endoscopic dilation, percutaneous nephrostomy tube, or ureteral stent. 1 ink patient required open reimplantation of UEA. CONCLUSIONS: Our pilot study demonstrates ink is well-visualized following injection near UEA during IC. However, the ink cohort had more UEAS than our prior rates of UEAS (6%) and in the literature. While this study sample is small, the higher development of UEAS after ink leads to question the utility and safety of ink injection following IC. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e942-e942 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mei Tuong More articles by this author Tracey Krupski More articles by this author Expand All Advertisement Loading ...

MP29-11 NEPHROSTOMY TUBE VS. URETERAL STENT FOR OBSTRUCTING SEPTIC CALCULI: A NATIONWIDE PROPENSITY SCORE MATCHED ANALYSIS

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II (MP29)1 Sep 2021MP29-11 NEPHROSTOMY TUBE VS. URETERAL STENT FOR OBSTRUCTING SEPTIC CALCULI: A NATIONWIDE PROPENSITY SCORE MATCHED ANALYSIS Rachel Wong, Sylvain Lother, Premal Patel, and Barret Rush Rachel WongRachel Wong More articles by this author , Sylvain LotherSylvain Lother More articles by this author , Premal PatelPremal Patel More articles by this author , and Barret RushBarret Rush More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002026.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sepsis secondary to obstructive uropathy is a Urological emergency associated with significant mortality and morbidity. Urgent decompression using retrograde placement of a ureteric stent (US) or a percutaneous nephrostomy tube (PCN) remains the gold standard of treatment in conjunction with fluid resuscitation and IV antibiotics. Prior literature suggests that advantages to PCN include higher insertion success rate as well as a shorter procedural time, which may account for the benefit in mortality. However, scant data exists regarding the optimal method for decompression. METHODS: Utilizing the National Inpatient Sample (NIS) database from 2006-2014 we created a cohort of patients ≥18 years of age with a diagnosis of sepsis and a ureteral/renal calculi that underwent US or PCN. A multivariate logistic regression model predicting in-hospital mortality was created incorporating the 29 Elixhauser comorbidities, hemodialysis, shock, and mechanical ventilation. Additionally, a propensity score matched cohort was created based on the propensity to receive each treatment. RESULTS: Of these, 9,828 (28.9%) patients underwent ureteral stenting and 24,181 (71.1%) underwent PCN. The unadjusted mortality rate for US patients was 2.8% compared to 5.3% in the PCN group (p <0.01). Patients who received US were more likely to be female (61.7% vs 53.8%, p <0.01), White (69.3% vs 64.5%, p <0.01), and have private health insurance coverage (26.5% vs 20.9%, p <0.01, Table 1). After adjustment for baseline characteristics, having a US compared to PCN was associated with a lower risk of mortality (OR 0.72, 95% CI 0.63-0.83, p <0.01) After matching patients based on propensity score, the mortality rate for patients who received a US was 3.5% compared to 3.9% in the PCN group (p=0.26). CONCLUSIONS: This large national analysis demonstrates that US placement in septic obstructive uropathy is associated with lower mortality compared to PCN. After propensity score matching this finding was no longer statistically significant. Further prospective randomized trials are needed to address this important clinical question. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e493-e494 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rachel Wong More articles by this author Sylvain Lother More articles by this author Premal Patel More articles by this author Barret Rush More articles by this author Expand All Advertisement Loading ...

Determining Variable Costs in the Acute Urolithiasis Cycle of Care Through Time-Driven Activity-Based Costing

ObjectiveTo characterize full cycle of care costs for managing an acute ureteral stone using time-driven activity-based costing. MethodsWe defined all phases of care for patients presenting with an acute ureteral stone and built an overarching process map. Maps for sub-processes were constructed through interviews with providers and direct observation of clinical spaces. This facilitated calculation of cost per minute for all aspects of care delivery, which were multiplied by associated process times. These were added to consumable costs to determine cost for each specific step and later aggregated to determine total cost for each sub-process. We compared costs of eight common clinical pathways for acute stone management, defining total cycle of care cost as the sum of all sub-processes that comprised each pathway. ResultsCost per sub-process included $920 for emergency department (ED) care, $1665 for operative stent placement, $2368 for percutaneous nephrostomy tube placement, $106 for urology clinic consultation, $238 for preoperative center visit, $4057 for ureteroscopy with laser lithotripsy (URS), $2923 for extracorporeal shock wave lithotripsy, $169 for clinic stent removal, $197 for abdominal x-ray, and $166 for ultrasound. The lowest cost pathway ($1388) was for medical expulsive therapy, whereas the most expensive pathway ($8002) entailed a repeat ED visit prompting temporizing stent placement and interval URS. ConclusionWe found a high degree of cost variation between care pathways common to management of acute ureteral stone episodes. Reliable cost accounting data and an understanding of variability in clinical pathway costs can inform value-based care redesign as payors move away from pure fee-for-service reimbursement.

Rethinking Time-to-Exchange: Outcomes of Nephrostomy Tube Placement in Pregnancy

This study evaluated outcomes for percutaneous nephrostomy tube placement in pregnant patients, including potential complications that required early, unplanned tube exchange. A retrospective review was conducted for 51 pregnant patients and a nonpregnant cohort matched 1:1 who received percutaneous nephrostomy tube placement between 2012 and 2020. Factors potentially contributing to unplanned tube exchanges were analyzed, including gestational age, prevalence and severity of hydronephrosis, presence of renal calculi, and serum calcium level. The mean tube exchange interval was significantly shorter in the pregnant group (3.4 weeks ± 1.8 [standard deviation] vs 5.7 weeks ± 0.7, P < .0001), and pregnant subjects were significantly more likely to require reintervention before the 6-week scheduled exchange (80.4% vs 21.6%, P < .0001). The serum calcium level was lower in pregnant subjects (8.4 mg/dL ± 0.4 vs 8.9 mg/dL ± 0.7, P = .002). A shorter interval schedule (every 3 weeks) of routine percutaneous nephrostomy tube exchange in pregnant patients may be necessary to avoid complications.

Health Education Intervention for Patients Undergoing Placement of Percutaneous Nephrostomy Tube: A Randomized Controlled Trial.

The purpose of this study was to compare the economic impact (cost) of percutaneous nephrostomy (PCN) tube care in patients following an educational intervention to no intervention. A randomized controlled trial. The sample comprised 178 patients recruited between May 2017 and April 2019. The study setting was the Marqués de Valdecilla University Hospital located in Cantabria on the northern coast of Spain. Data were collected in the hospital's radiology department. Participants were randomly allocated to 2 groups: an intervention group received an educational intervention that specifically addressed living with a PCN tube and a control group that received standard instruction. The intervention group received the educational intervention twice, before placement of the nephrostomy and at first tube change (6 weeks later). The main outcome variable was economic impact of the PCN, operationally defined as unscheduled or urgent visits and health care costs related to PCN tube placement. When compared to control group subjects, participants who received the educational intervention had fewer urgent (unscheduled) visits (1.9 vs 4.0; P = .004) and lower direct and indirect health care costs reflecting a savings of €5277 (approximately US $6257). The health education intervention reduced costs associated with these additional visits when compared to patients receiving standard postprocedural education.

AUTHOR REPLY

We thank you for your insightful comments. In patients with recent instrumentation of a ureteral stricture and/or the presence of hardware across a ureteral stricture, our preference is to initiate a period of rest after placing a percutaneous nephrostomy tube. This practice is based on our hypothesis that rest allows for uninterrupted progression through the stages of wound healing and stricture stabilization, while the presence of hardware acrossa stricture impedes wound healing by perpetuating the inflammatory phase of wound healing.

MO408OBSTRUCTIVE NEPHROPATHY - STILL PREVALENT DISEASE

Abstract Background and Aims Acute kidney injury (AKI) secondary to urinary obstruction is a common urological-nephrological problem. In this retrospective study, our goals were to describe the etiology, management and outcomes of patients with obstructive nephropathy who were hospitalized at Nephrology Department during 2019. Method AKI was defined by the RIFLE classification. Diagnosis of obstruction was defined by ultrasound imaging, intravenous pyelography and CT scan. Results During 2019 AKI secondary to urinary obstruction was diagnosed to 64 patients. 73% of them were male, average age 65 ± 16 years. About 60% of the patients had bilateral hydronephrosis, chronic kidney disease and anuria duration longer than 24h. The following desobstructive procedures were applied: urinary catheterization to 33 patients, percutaneous nephrostomy tube to 14 patients, double-J stent to 7 and other procedures to 10 patients. The most common causes of obstruction were malignancy and benign prostatic hyperplasia 60%, calculosis 17%, and other causes 20% such as neurogenic bladder and retroperitoneal fibrosis. As many as 30% of patients required acute hemodialysis treatment, of which 6% remained on a chronic program in period of three months. Out of all, 30% of patients had a partial recovery of kidney function, while 20% had complete recovery. The most common complication was infection and bleeding. The univariate logistic regression, adjusted for age and hemodialysis treatment, has shown that significant independent predictors for chronic kidney disease progression were anuria duration &amp;gt;24h (RR 2.21; 95% CI 0.014-1.03; p=0.05), polyuria duration (RR 2.11; 95% CI 1.112-3.98; p=0.02) and duration of hospital treatment (RR 9.16; 95% CI 2.102-39.94; p=0.03). The most significant predictor of death was duration of hospital treatment (RR 9.16; 95% CI 2.102-3.399; p=0.003). Multivariate logistic regression did not shown significance any of the above risk factors. Conclusion Given that third of patients with obstructive nephropathy require acute HD, 6% remain in chronic HD, and almost one third require rehospitalization, close cooperation between a nephrologist and urologist is required. Rapid desobstructive procedures and careful monitoring after desobstruction is warranted. Requirement of regular screening remains opened for obstruction in vulnerable populations.

MO408OBSTRUCTIVE NEPHROPATHY - STILL PREVALENT DISEASE

Abstract Background and Aims Acute kidney injury (AKI) secondary to urinary obstruction is a common urological-nephrological problem. In this retrospective study, our goals were to describe the etiology, management and outcomes of patients with obstructive nephropathy who were hospitalized at Nephrology Department during 2019. Method AKI was defined by the RIFLE classification. Diagnosis of obstruction was defined by ultrasound imaging, intravenous pyelography and CT scan. Results During 2019 AKI secondary to urinary obstruction was diagnosed to 64 patients. 73% of them were male, average age 65 ± 16 years. About 60% of the patients had bilateral hydronephrosis, chronic kidney disease and anuria duration longer than 24h. The following desobstructive procedures were applied: urinary catheterization to 33 patients, percutaneous nephrostomy tube to 14 patients, double-J stent to 7 and other procedures to 10 patients. The most common causes of obstruction were malignancy and benign prostatic hyperplasia 60%, calculosis 17%, and other causes 20% such as neurogenic bladder and retroperitoneal fibrosis. As many as 30% of patients required acute hemodialysis treatment, of which 6% remained on a chronic program in period of three months. Out of all, 30% of patients had a partial recovery of kidney function, while 20% had complete recovery. The most common complication was infection and bleeding. The univariate logistic regression, adjusted for age and hemodialysis treatment, has shown that significant independent predictors for chronic kidney disease progression were anuria duration &amp;gt;24h (RR 2.21; 95% CI 0.014-1.03; p=0.05), polyuria duration (RR 2.11; 95% CI 1.112-3.98; p=0.02) and duration of hospital treatment (RR 9.16; 95% CI 2.102-39.94; p=0.03). The most significant predictor of death was duration of hospital treatment (RR 9.16; 95% CI 2.102-3.399; p=0.003). Multivariate logistic regression did not shown significance any of the above risk factors. Conclusion Given that third of patients with obstructive nephropathy require acute HD, 6% remain in chronic HD, and almost one third require rehospitalization, close cooperation between a nephrologist and urologist is required. Rapid desobstructive procedures and careful monitoring after desobstruction is warranted. Requirement of regular screening remains opened for obstruction in vulnerable populations.

Case - Endoscopic management of severe ventral urine leak post-robot-assisted laparoscopic prostatectomy.

Vesicourethral leakage following robot-assisted laparoscopic prostatectomy is an uncommon complication, and the majority of cases are managed conservatively. Persistent leakage, which is refractory to conservative measures, may require more invasive management. Herein, we describe a novel approach for managing urine leaks endoscopically, without the need for percutaneous nephrostomy tube insertion.

Abstract No. 213 Efficacy for urinary diversion via percutaneous nephrostomy tubes to treat hemorrhagic cystitis

Hemorrhagic cystitis (HC) is diffuse hemorrhage of the bladder mucosa that can lead to anemia requiring transfusions and bladder outlet obstruction. In severe cases that are refractory to conservative treatment, urinary diversion utilizing percutaneous nephrostomy tubes (PCN) has been reported. However, there is a paucity of data regarding the efficacy and safety of PCNs for severe HC. We present the largest case series to date of HC treated with PCNs for urinary diversion. An IRB-approved, retrospective, single-center cohort study was conducted in patients with HC who had PCNs placed for urinary diversion between 2004 and 2020. Diagnosis of HC was determined on clinical and/or cystoscopic examination. 24 patients (median age 59 years; 17/7 M/F ratio) were identified. Etiology of HC included radiation (12), BK virus (6), and other (6), with a median CTCAE severity grade of 3 (range 2-4). Mann-Whitney test with P value < 0.05 was used to determine significance. PCN placement procedure had a primary technical success rate of 23/24 (96%). Median post-procedure CTCAE severity score was 1 (range 0-4), a mean decrease of 1.95 compared to pre-procedure. Resolution of hematuria occurred in 17/24 cases (71%); median time for hematuria to resolve after procedure was 12 days (range 3-71). Postoperative hemoglobin increased (mean 7.4 g/dL at the time of procedure to 8.3 g/dL 3 days post-operative, P< 0.05) and transfusion requirement decreased (mean 7.3 units PRBC within 30 days prior to the procedure to 3.4 units PRBC within 30 days following the procedure, P< 0.05). 4/17 patients demonstrated subsequent recurrence of hematuria; median time to recurrence of hematuria was 60 days (range 12-200). 5/24 patients died within 30 days of the procedure; however, no death was attributed directly to HC or PCN placement. Urinary diversion from PCN placement is a safe and efficacious treatment for severe, treatment-refractory HC.

Abstract No. 511 Impact of practicing clinical interventional radiology: nephrostomy tube care in cancer patients, a quality improvement initiative

To evaluate the impact of a defined quality improvement interventional radiology (IR) driven nephrostomy tube clinic on cancer patients in a high-volume tertiary care safety net hospital. A quality improvement (QI) process was established at our institution to increase compliance with percutaneous nephrostomy (PCN) tube follow-up care by starting an IR PCN care clinic in 2015. We conducted a retrospective review of 2 cohorts of cancer patients who underwent PCN placement either before or after implementation of the PCN clinic. The pre-implementation cohort (January 1, 2013 to December 31, 2013) was compared to the post-implementation cohort (January 1, 2018 to December 31, 2018) for compliance of follow-up tube exchange and complications of indwelling nephrostomy. Cost of emergency room (ER) and clinic visits (for the post-implementation cohort) as well as duration between exchanges were collected. Wilcoxon rank sum tests and Fisher’s exact test were used to test difference between pre- and post-implementation costs. Equality of variance in duration was tested using F test. P < 0.05 was considered statistically significant. For the 27 pre-implementation and 28 post-implementation patients, we included 38 and 31 exchanges, respectively. After the implementation of the IR PCN clinic, the 2018 to 2019 cohort had significantly lower standard deviation in the duration between exchanges than the 2013 to 2014 pre-implementation cohort (16 days vs. 48 days, P < 0.0001), indicating better compliance of exchanges at 90 days. Additionally, the pre-implementation cohort had a longer duration between exchanges on average (95 days vs. 91 days, P = 0.032). Of the 38 pre-implementation exchanges, 9 (24%) were preceded by at least 1 ER visit, while 4 (13%) of 31 post-implementation exchanges were preceded by at least 1 ER visit (P = 0.29). The implementation of an IR PCN clinic improves patient compliance of PCN exchanges every 3 months and may decrease ER visits prior to exchanges. The IR clinician plays a key role in management of these patients and improving their quality of life.