Percutaneous Nephrostomy Placement Research Articles

The efficacy and safety of retrograde ureteral stenting in the management of complicated cases of ureteral obstruction caused by urolithiasis.

To investigate the efficacy and safety of retrograde double J stent (RDJS) placement in the management of complicated obstructive uropathy caused by urolithiasis. An observational study done at a tertiary center was implemented in which a total of 27 patients (10 males, 17 females) with average age of 48.74 years (range: 15-88) who underwent RDJS or percutaneous nephrostomy (PCN) between 2017 and 2021 due to complicated obstruction caused by urolithiasis were included. A total of 27 patients (10 males, 17 females) with average age of 48.74 years (range: 15-88) who underwent kidney decompression between 2017 and 2021 due to complicated unilateral or bilateral kidney obstruction caused by ureteral stones were included. Twenty-two patients (81.48%) underwent successful RDJS placement, two patients had RDJS placement then PCN was also placed, and two patients underwent PCN placement. Three patients needed an intensive care unit "ICU" after intervention, two of them were in the ICU before intervention. All septic parameters were normalized within a short period postoperatively. Two patients with failed previous ureteroscopy had a successful RDJS placement. Retrograde DJS placement is a feasible option in the management of complicated cases of obstructive uropathy caused by urolithiasis. Short hospitalization period, low rate of complications and better quality of life are the most prominent advantages of RDJS placement. In the hands of experienced surgeons, RDJS should be offered as the first choice of decompression for obstructive uropathy caused by urolithiasis.

Comparison Efficacy between Percutaneous Nephrostomy and Double J Stent in Management of Obstructive Uropathy

Background: The prevalence of urolithiasis and associated acute kidney injury (AKI) has seen a notable increase in recent decades, particularly in developing countries such as Pakistan, which falls within the "stone forming belt" region. This rise has underscored the need for effective management strategies for obstructive uropathy, a potentially reversible condition if timely intervention is provided. However, the literature reveals a divergence in treatment approaches between different regions and among healthcare professionals, with no universally recommended treatment for relieving the obstructed system. Objective: This study aimed to evaluate and compare the efficacy of percutaneous nephrostomy (PCN) versus Double J stent (DJS) in the management of obstructive uropathy secondary to urolithiasis in patients with elevated serum creatinine levels. Methods: Conducted as a randomized controlled trial at the Jinnah Postgraduate Medical Center Karachi from January 2023 to December 2023, the study included patients aged 20 to 50 years with obstructive uropathy secondary to urolithiasis and serum creatinine above or equal to 2.0 mg/dL. Exclusion criteria encompassed obstructive uropathy due to bladder outlet obstruction, uncontrolled coagulopathy, and lack of consent. Participants were randomized into two groups for either PCN or DJS placement, with pre-operative and post-procedure serum creatinine and urea levels measured at multiple intervals. Data analysis was performed using SPSS version 25. Results: The study enrolled 30 patients in the PCN group and 30 in the DJS group. Efficacy rates for PCN and DJS were 93.3% (28 out of 30) and 76.7% (23 out of 30), respectively. Stratified analysis revealed no statistically significant differences in efficacy based on age, gender, or duration of illness, although a trend favoring PCN was observed in patients over 40 years and those treated within 5-10 days of illness onset. Conclusion: While both PCN and DJS are effective interventions for obstructive uropathy secondary to urolithiasis, PCN showed a non-significantly higher overall efficacy. These findings suggest a potential preference for PCN in certain patient subsets, though further research with larger sample sizes and multi-center trials is needed to substantiate these observations.

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.

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.

#6056 NEPHROLOGIC INVOLVEMENT IN A SURGICAL COMPLICATION: WHEN TO SUSPECT A PYELO-DUODENAL FISTULA

Abstract Background and Aims Spontaneous pyeloduodenal fistula is a rare condition occurring primarily after urologic events, in most cases infected kidney stones, pyonephrosis, xanthogranulomatous pyelonephritis, renal tumors, and infected renal cysts, with nowadays 80 cases described. The close relationship between the kidney and the duodenum is a facilitating condition. Method We describe the case of a 78 yo woman admitted in April 2022 for Acute Kidney Injury associated with fever, vomiting, oliguria and metabolic alkalosis. Over the last two years the patient reported recurrent febrile episodes associated with abdominal tenderness and weight loss. Urine cultures showed recurrent bacterial growth and she received antibiotics for recurrent episodes of pyelonephritis and lower urinary tract infections (K. Pneumonie ESBL +, E. Faecalis, P. Mirabilis). She was under nephrologic follow-up with a renal function demonstrating eGFR CKD-EPI of 35-30 ml/min/1.73 m2. In past medical history she reported atrial fibrillation in DOAC, heart failure with preserved ejection fraction, hypertension, previous left occipito-parietal ischemic stroke and right parotid adenoma. On physical examination of the abdomen there was no tenderness, mild pain in the right hypochondrium, Giordano's maneuver mild positive on the right side. Because of the evidence of lithiasis in the right kidney on ultrasound with grade III hydroureteronephrosis, we performed a CT scan with contrast, finding imaging compatible with right pyelonephritis with associated grade IV hydronephrosis, in particular lithiasic formation localized at the level of the right pyelo-ureteral junction (2 × 1cm), with partial involvement of the proximal portion of the ureter, severe calico-pyelic dilatation with overall reduction of the cortico-medullary thickness; diffuse inhomogeneity of the middle and lower thirds of the renal parenchyma, with evidence of some bubbles in contextual areas and inhomogeneity of the perirenal adipose tissue. Reduced nephrographic effect in the post-contrastographic phases and lack of elimination of the contrast in the urographic phase (12 min) were reported. She was started on antibiotics piperacillin-tazobactam and underwent right percutaneous nephrostomy placement. During the procedure we evidenced a communication between the calyx of the right upper calyceal group and an intestinal loop, probably the duodenum (Fig. 1). Results The patient underwent elective laparotomic surgery for right nephrectomy (Fig. 2) and closure of the intestinal fistula with duodenoraffia and omental patch. She was admitted to a post-operative intensive care unit, given comorbidities and the complexity of the operation. She was discharged in 9 days without post-operative complications, with stable renal function. One month after discharge the patient died of pneumonia. Conclusion Pyeloduodenal fistula is an infrequent condition causing occasional or continuous passing of materials between the alimentary canal and urinary tract. The presence of gastrointestinal symptoms and urinary tract alterations may be misinterpreted when occurring. Management of this case required collaboration between several specialists, with particular skills on AKI and CKD, infective complications, interventional radiology and surgical procedures. The outcome was strongly affected by the patient's general condition and comorbidities, with a good short-term outcome but complications on the long-term follow-up. The occurrence of air in the urinary tract is strongly suggestive of communications across the renal pelvis and the gastrointestinal tract. In particular if occurring in the setting of recurrent infections and nephrolithiasis, the diagnosis of pyelo-intestinal fistula should be considered.

Rare Complication of Percutaneous Nephrolithotomy: Nephrostomy Tube in Renal Vein and Inferior Vena Cava

Percutaneous nephrolithotomy (PCNL) is considered as the gold standard treatment for renal stones > 2cm. We encountered a patient who underwent PCNL and inadvertently placement ofpercutaneous nephrostomy tube in the inferior vena cava through the left renal vein from the left Kidney.There was profuse bleeding during the procedure (PCNL), and the procedure was abandoned by placing a nephrostomy tube. PNT was removed after 04 days in two steps without any bleeding.

Percutaneous nephrostomy experience in pediatric patients: comparison of fine and thick needle techniques

Objectives: The aim of this study is to assess the effect of needle size in pediatric percutaneous nephrostomy (PN) placement in terms of complications and success rates. Methods: Seventy one percutaneous nephrostomies were performed in 51 patients aged 1 month to 18 years (mean 6.03 ± 5.88 years) between May 2012 and March 2020. Demographic data, indication for PN placement, puncture technique (calyceal entry level: upper, middle, lower pole or pelvis) and needle size, anesthesia type (general or local anesthesia), duration of catheter use and complications were retrospectively retrieved from the hospital electronic recording system. Results: Thirty procedures were performed using a 21 gauge needle and 41 procedures using a 18 gauge needle. There was no statistically significant difference between the two groups in terms of age, gender, degree of hydronephrosis, and calyceal entry level. Technical success and complication rates were similar in two groups (p = 0.423). Conclusions: In the pediatric age group, both 18 and 21 gauge needle techniques can be used safely based on the preference of the interventionalist.

Abstract No. 107 Developing a Training Model for Percutaneous Nephrostomy Placement under Ultrasound and Fluoroscopy Guidance

Abstract No. 107 Developing a Training Model for Percutaneous Nephrostomy Placement under Ultrasound and Fluoroscopy Guidance

Twenty-Four-Month Efficacy of Ureteroureterostomy Combined With Unilateral Nephrostomy Following Radical Cystectomy

Introduction The purpose of this study was to evaluate the 24-month outcomes of ureteroureterostomy combined with unilateral nephrostomy following radical cystectomy in patients with muscle-invasive bladder cancer (BC). Materials and methods This single-center study with prospectively collected data with retrospective data analysis was carried out between December 2018 and November 2021 and enrolled 36 patients, who underwent radical cystectomy combined with ureteroureterostomy and unilateral nephrostomy. Regular renal function assessment was carried out using serum creatinine and estimated glomerular filtration rate (eGFR), and postoperative complications, endoscopic, ultrasound, and other radiological study findings were evaluated. The follow-up of the patients was carried out over a period of 24 months. Results After completion of the 24-month follow-up, the renal function proved to be slightly improved (mean serum creatinine and eGFR values of 1.38±0.72 mg/dL and 55.9±21.87 mL/min) compared to the first-year results (1.41±0.54 mg/dL and 52.10±19.64 mL/min). However, this improvement is statistically not significant (p=0.44, p=0.30). The 24-month follow-up imaging findings remained stable in 97.22% of patients compared to the first-year results, with preservation of bilateral ureteric dilatation and grade 1 dilatation of the non-drained kidney. No case of acute pyelonephritis was recorded after the completion of the second year of follow-up, in comparison to the eight patients (22.22%) of the 12-month follow-up, who sufferedacute pyelonephritis. After completing of the 24-month follow-up, one patient was excluded from further analysis, due to the placement of a second permanent percutaneous nephrostomy in the non-drained kidney, due to ureteroureterostomy stenosis with consecutive hydronephrosis in the contralateral kidney and acute renal failure. No case of anastomotic leak was observed. Conclusions The function of the ureteroureterostomy combined with unilateral nephrostomy is proven to be a safe method of urinary diversion (UD) at 24 months, with minimal and easily manageable complications. Only one case of stenosis of the ureteroureterostomy with consecutive acute renal failure due to hydronephrosis in the non-drained kidney was observed. The renal function remained stable.

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.

Novel Coaxial Technique of Percutaneous Nephrostomy in Young Children: A Feasibility Study.

The conventional Seldinger and trocar techniques of percutaneous nephrostomy (PCN) have inherent limitations in infants and younger children. We studied the role of a novel coaxial technique of PCN in children under the age of 5 years in comparison to the conventional techniques. This was a single-center feasibility trial based on 24 consecutive patients (n = 24 kidneys) under the age of 5 years, conducted over 12 months, substratified into Group I (n = 10): PCN with conventional Seldinger (n = 2) and trocar (n = 8) techniques and Group II (n = 14): PCN with proposed coaxial technique. In the proposed technique, catheter was inserted through the bore of a 14-G needle. The observation parameters included successful placement of PCN into the renal pelvis with free drainage of urine, number of needle punctures, duration of procedure, need for fluoroscopy, and procedural complications. Proposed technique was successful in all cases with single-needle puncture, while conventional techniques were successful in 8/10 (80%) cases with multiple needle punctures required in 3/10 (33.3%) cases (P = 0.163 and 0.059, respectively). Proposed technique was associated with lower median procedure time (6 min vs. 10.5 min; P < 0.001) and lower incidence of fluoroscopy use (0/14, 0% vs. 5/10, 50%; P = 0.006) than the conventional techniques. No complications were seen with either technique. The proposed coaxial technique is a feasible alternative to the conventional techniques of PCN in young children. It reduces the procedure time and the need for fluoroscopy in these patients.

Factors Associated with Ureteral Stent Failure in Patients with Malignant Ureteral Obstruction.

Introduction: Management of malignant ureteral obstruction (MUO) with ureteral stents remains a clinical challenge, often involving frequent stent exchanges attributable to stent failure or other urological complications. We report our institutional experience with ureteral stents for management of MUO, including analysis of clinical factors associated with stent failure. Methods: We performed a retrospective review of patients treated with indwelling ureteral stents for MUO in nonurothelial malignancies at our tertiary-care institution between 2008 and 2019. Univariate Cox proportional hazards analysis was performed to identify clinical variables associated with stent failure and stent-related complications. Stent failure was defined as need for unplanned stent exchange, placement of percutaneous nephrostomy (PCN), or tandem stents. Results: In our cohort of 78 patients, the median (range) number of stent exchanges was 2 (0-17) during a total stent dwell time of 4.3 (0.1-40.3) months. Thirty-four patients (43.6%) developed a culture-proven urinary tract infection (UTI) during stent dwell time. Thirty-five patients (44.8%) had stent failure. Twenty-two patients (28.2%) underwent unplanned stent exchanges, 23 (29.5%) required PCN after initial stent placement, and 6 (7.7%) required tandem stents. Ten (28.6%) patients with stent failure were treated with upsized stents, which led to resolution in seven patients. Stent failure occurred with 20/44 (45.4%) Percuflex™, 15/27 (55.6%) polyurethane, and 2/3 (66.7%) metal stents. In patients with ≥2 exchanges (N = 45), median time between exchanges was 4.1 (2.0-14.8) months. Bilateral stenting and history of radiation predicted UTI development. Median overall patient survival after initial stent placement was 19.9 months (95% CI 16.5-37.9 months). Conclusions: Ureteral stent failure poses a significant medical burden to patients with MUO. Better methods to minimize stent-related issues and improve patient quality of life are needed. Using a shared decision-making approach, clinicians and patients should consider PCN or tandem stents early in the management of MUO.

Establishment of a Percutaneous Nephrostomy Service to Treat Obstructive Uropathy Secondary to Cervical Cancer in Tanzania

Abstract Background Cervical cancer is the fourth most common cancer among women globally. Age-standardized cervical cancer mortality is higher in East Africa than anywhere else in the world. Prior to October 2018, patients presenting with obstructive uropathy secondary to late-stage cervical cancer in Tanzania who were no longer eligible for palliative chemoradiation therapy were discharged home without intervention. The purpose of this study was to evaluate whether the establishment of a percutaneous nephrostomy service in a quaternary hospital in Dar es Salaam, Tanzania, a resource-limited country, benefits patients who have late-stage cancer induced obstructive uropathy. Materials and Methods A retrospective study was performed on patients who presented with obstructive uropathy secondary to late-stage cervical cancer and have undergone percutaneous nephrostomy at Muhimbili National Hospital and Ocean Road Cancer Institute from October 2018 to May 2021. Twenty-one interventional radiology (IR) teaching teams consisting of IR attendings, IR technologists, and nurses travelled to Tanzania from North America on monthly 2-week trips during that period. A review of preprocedural, procedural, and follow-up data was performed using Research Electronic Data Capture. Statistical analysis and comparison were performed on patients' creatinine levels preprocedure, 7 days and 30 days postprocedure. Results Sixty-two patients qualified to be included in this study. In addition to the initial 62 nephrostomy placements, 14 follow-up procedures were performed either under visiting faculty supervision or independently by the Tanzanian IR fellows. Technical success rate was 98.7%. Complications (SIR Class A and B) occurred in eight cases. The average preprocedure creatinine (1051.48 ± 704.08µmol/L) decreased by 59% 7 days postprocedure and by 77% 30 days postintervention. Postprocedural clinical information was obtained for 28 (45.2%) patients and 18 were able to restart chemotherapy following nephrostomy. Conclusion Prior to 2018, percutaneous nephrostomy placement was not available in Tanzania. This study presented the initial safety, technical feasibility, and clinical benefit of establishing a percutaneous nephrostomy service in such a resource-limited setting.

MP53-13 PROGNOSTIC FACTORS FOR OVERALL SURVIVAL IN MALIGNANT URETERAL OBSTRUCTION

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (MP53)1 Sep 2021MP53-13 PROGNOSTIC FACTORS FOR OVERALL SURVIVAL IN MALIGNANT URETERAL OBSTRUCTION Michael Creswell, Jillian Egan, J Bradley Mason, Christopher Dall, Tamir Sholklapper, Lan Anh Galloway, Joanna Orzel, Harry Lee, Sameer Desale, and Lambros Stamatakis Michael CreswellMichael Creswell More articles by this author , Jillian EganJillian Egan More articles by this author , J Bradley MasonJ Bradley Mason More articles by this author , Christopher DallChristopher Dall More articles by this author , Tamir SholklapperTamir Sholklapper More articles by this author , Lan Anh GallowayLan Anh Galloway More articles by this author , Joanna OrzelJoanna Orzel More articles by this author , Harry LeeHarry Lee More articles by this author , Sameer DesaleSameer Desale More articles by this author , and Lambros StamatakisLambros Stamatakis More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002083.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral obstruction is common in the setting of advanced gynecologic malignancies (GM). Prior studies have investigated prognostic factors associated with overall survival (OS) for patients with malignant ureteral obstruction (MUO), but data is overall sparse. This information is important for appropriate patient counseling regarding the risks and benefits of urinary diversion in this setting. We attempted to identify prognostic factors for OS and stent failure (SF) in patients with MUO from GM. METHODS: A retrospective review of 126 patients with MUO from GM at two academic centers was performed. Clinical and laboratory data for patients > 18 years and a diagnosis of hydronephrosis and GM from 2011-2019 were collected. Factors related to OS were determined using a Cox regression proportional hazard model. In patients with incomplete survival data (n=30), hospice was used as a surrogate for death. RESULTS: OS of <6 months, 6-12 months, and >12 months was 52%, 8%, and 40%, respectively. On univariate analysis, age at diagnosis, Charlson Comorbidity Index (CCI) > 8, advanced clinical stage, ascites, pleural effusion, albumin at intervention and hemoglobin at intervention were associated with poor OS. OS was higher for those who received ureteral stent as compared to those with no intervention or percutaneous nephrostomy (PCN) placement. There was no survival difference based on severity of hydronephrosis, occurrence of SF, or creatinine at the time of intervention. CONCLUSIONS: OS in patients with MUO is poor. 52% will die or be in hospice within 6 months of hydronephrosis. Several prognostic factors for poor survival were identified. Ureteral stenting was associated improved OS, but selection bias likely contributed to this result. Additional studies are needed to clarify this finding. These data can be utilized to counsel patients regarding outcomes after urinary diversion in the setting of MUO. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e943-e944 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Creswell More articles by this author Jillian Egan More articles by this author J Bradley Mason More articles by this author Christopher Dall More articles by this author Tamir Sholklapper More articles by this author Lan Anh Galloway More articles by this author Joanna Orzel More articles by this author Harry Lee More articles by this author Sameer Desale More articles by this author Lambros Stamatakis More articles by this author Expand All Advertisement Loading ...

Bilgisayarlı tomografi ve floroskopi kılavuzluğunda perkütan nefrostomi işlemlerindeki radyasyon maruziyeti için bir retrospektif kıyaslama

Objective: The study aimed to compare the radiation doses absorbed by the patient in first-time percutaneous nephrostomy under CT and nephrostomy replacement under fluoroscopy. &#x0D; Materials and Methods: 89 hydronephrotic patients referred for nephrostomy were included in this retrospective study. 75 of these patients had the nephrostomy for the first-time under CT-guidance. 14 patients had the nephrostomy replacement operation under fluoroscopy guidance. Absorbed radiation doses were compared between these operations. &#x0D; Results: The groups showed no statistically significant differences in means of demography (age, sex, and pathology) and operational parameters (intervention side and complications) except the absorbed radiation dose. The median effective radiation doses were 1.18 mSv and 1.68 mSv for CT and fluoroscopy, respectively. The first-time nephrostomy operations under CT were completed with radiation doses significantly lower than those in nephrostomy replacement under fluoroscopy (p &lt; 0.001). &#x0D; Conclusion: Ultra-low-dose and fast-acting CT-guided nephrostomy is a safe, user-friendly procedure that leads patients to less radiation exposure than expected. CT guidance is a better alternative than fluoroscopy in percutaneous nephrostomy placement with a low complication rate in patients with different indications and a wide age interval.

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.

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.

Financial Effect of Unbundling Moderate Sedation from Procedural Codes in Radiology

PurposeTo assess and quantify the financial effect of unbundling newly unbundled moderate sedation codes across major payors at an academic radiology practice. Materials and MethodsBilling and reimbursement data for 23 months of unbundled moderate sedation codes were analyzed for reimbursement rates and trends. This included 10,481 and 28,189 units billed and $443,257 and $226,444 total receipts for codes 99152 (initial 15 minutes of moderate sedation) and 99153 (each subsequent 15 minute increment of moderate sedation), respectively. Five index procedures—(i) central venous port placement, (ii) endovascular tumor embolization, (iii) tunneled central venous catheter placement, (iv) percutaneous gastrostomy placement, and (v) percutaneous nephrostomy placement—were identified, and moderate sedation reimbursements for Medicare and the dominant private payor were calculated and compared to pre-bundled reimbursements. Revenue variation models across different patient insurance mixes were then created using averages from 4 common practice settings among radiologists (independent practices, all hospitals, safety-net hospitals, and non-safety-net hospitals). ResultsDepartmental reimbursement for unbundled moderate sedation in FY2018 and FY2019 totaled $669,701.34, with high per-unit variability across payors, especially for code 99153. Across the 5 index procedures, moderate sedation reimbursement decreased 1.3% after unbundling and accounted for 3.9% of procedural revenue from Medicare and increased 11.9% and accounted for 5.5% of procedural revenue from the dominant private payor. Between different patient insurance mix models, estimated reimbursement from moderate sedation varied by as much as 29.9%. ConclusionsDepartmental reimbursement from billing the new unbundled moderate sedation codes was sizable and heterogeneous, highlighting the need for consistent and accurate reporting of moderate sedation. Total collections vary by case mix, patient insurance mix, and negotiated reimbursement rates.

Percutaneous Nephrostomy in the Neonatal Period: Indications, Complications, and Outcome-A Single Centre Experience.

The purpose of this study was to evaluate the indications, technique for percutaneous nephrostomy (PCN) insertion, the complications related to PCN, duration of PCN, and outcome following PCN removal regarding the kidney function. Medical charts of 31 neonates (22 boys and 9 girls, mean age 13.9days) treated with 43 PCN were reviewed. Collected data included indications for PCN, PCN complications, duration of PCN, and outcome of these patients by analysing the kidney function. The indications for PCN insertion were obstructive urinary tract dilation in 24 neonates (four with associated infection), and non-obstructive urinary tract dilation with urosepsis or pyonephrosis in seven cases. Primary technical success of PCN placement using Seldinger technique was 97.7%. The following complications were reported: self-limited post-procedural bleeding into the pelvicalyceal system in two, chronic microscopic haematuria in five, and clinically manifested urinary tract infection in five children. Four PCN were dislocated. Cellulitis was present at the skin entry of 5 PCN, urinary leak in 5 PCN, and mechanical damage of 5 PCN. Eight PCN had to be replaced. Mean duration of PCN was 5months. Kidney insufficiency was detected in 5/29 children with the mean follow-up of 3.9years. PCN is a safe, effective transient solution in neonates with pyonephrosis or when surgery of obstructed urinary system has to be postponed. The rate of minor complications increased with PCN duration. If kidney insufficiency is present after PCN removal, it is related to the complexity of kidney anomalies.

Personal Protective Equipment for Common Urologic Procedures Before and During the United States COVID-19 Pandemic: A Single Institution Study

OBJECTIVETo evaluate the personal protective equipment (PPE) utilized in common urologic procedures before and during the COVID-19 outbreak in the United States. As elective urologic procedures are being reduced to conserve resources, we sought to quantify the PPE used per case to determine the impact on potentially limited resources needed for protecting healthcare providers treating COVID-19 patients.METHODSAn IRB approved retrospective analysis of all urologic procedures in March 2019 and March 2020 was performed. Additionally, all urologic procedures performed by vascular interventional radiology (VIR) in May 2019 and March 2020 were included in the analysis. Case length, surgical and operating room staff present and number of articles of PPE were quantified. Articles of PPE were defined as surgical bonnet/hat and mask, and disposable or reusable gown with 1 pair of surgical gloves.RESULTSFour hundred and thirty-seven urologic and VIR procedures were included in the analysis. The mean PPE per case varied significantly between endoscopic and robotic categories. Robotic assisted laparoscopic cystectomy required the most hats and masks (14.5 per case in March 2019) whereas percutaneous nephrostomy tube placement by VIR required the fewest (3.1 in May 2019 and March 2020).CONCLUSIONPPE consumption varied significantly across urologic procedures. Robotic-assisted cases require the most PPE and percutaneous nephrostomy placement by VIR requires the fewest. While PPE shortages are currently being addressed national and internationally, our results provide a baseline benchmark for articles of PPE required should another pandemic or global disaster requiring careful attention to resource allocation occur in the future.