Ultrasound-guided Percutaneous Nephrostomy Research Articles

Efficacy and Safety of Double J Stenting (DJS) and Percutaneous Nephrostomy (PCN) in Patients with Obstructive Uropathy

Background: Obstructive uropathy is a condition characterized by the blockage of urine flow, which can lead to renal parenchymal damage and, if left untreated, potentially fatal outcomes. The condition arises from various causes, including stone disease, which remains the predominant factor. Management strategies such as Double J Stenting (DJS) and Percutaneous Nephrostomy (PCN) are employed to temporarily alleviate the obstruction, yet the comparative efficacy and safety profiles of these interventions remain to be thoroughly evaluated. Objective: To compare the efficacy and safety of ultrasound-guided percutaneous nephrostomy and double J stenting in the temporary diversion of urine in patients with obstructive uropathy, with a focus on procedural success rates, complication rates, and overall patient outcomes. Methods: This randomized controlled trial was conducted at the Department of Urology, Lady Reading Hospital, Peshawar, from January 1st, 2023, to December 31st, 2023. A total of 428 patients with obstructive uropathy, aged between 20 and 60 years, were randomized into two groups: the DJS group (n=214) and the PCN group (n=214). Exclusion criteria included severe coagulopathy and uremic encephalopathy. Efficacy was determined by the resolution of obstruction signs, and safety was assessed by the incidence of complications such as trigonalgia, hematuria, and septicemia within four weeks post-procedure. Statistical analysis was performed using IBM SPSS version 25. Results: The DJS group demonstrated a procedural success rate of 96.0%, while the PCN group showed a slightly higher success rate of 97.5%. Complication rates were comparably low across both groups, with trigonalgia (28.0% in DJS vs. 25.0% in PCN), hematuria (16.0% in DJS vs. 14.0% in PCN), and septicemia (6.5% in DJS vs. 8.4% in PCN). The efficacy in alleviating obstructive symptoms was 82.2% for DJS and 86.9% for PCN, with no statistically significant difference between the groups (p=0.180). Conclusion: Both double J stenting and percutaneous nephrostomy are effective and safe methods for temporary urine diversion in patients with obstructive uropathy. Although the PCN group exhibited a slightly higher success rate and a marginally lower complication rate, the differences were not statistically significant, indicating that the choice of procedure can be tailored to the individual patient's condition and the specific clinical scenario.

Problems with Adults Following Ultrasound-Guided Percutaneous Nephrostomy. A retrospective study

Background: Obstructive uropathy, which represents 10% of acute renal failure, calls for effective remedies. Percutaneous nephrostomy (PCN) is increasingly used in the treatment of obstructions in the renal collecting system. This Institute of Kidney Diseases study from the city of Peshawar in Pakistan now remedies a lack of knowledge in adult PCN guided by ultrasonography. Objectives: With this retrospective survey we wanted to know which patients are suitable candidates for PCN; what is the success rate; and how often complications arise using PCN that is guided by the use of ultrasound technology. Methods: We did a retrospective analysis in the Institute of Kidney Diseases, Peshawar, of those persons who had ultrasound-guided PCN for obstructive uropathy from January 5, 2022 to December 31, 2023. Data were from the Department of Urology registrations and HIS Records. Subjects must be over 16 years old. Exclusion criteria were incomplete records, pregnancy, and non-obstructive uropathy indications: those things should not have made it into the sample!IBM SPSS was used to do data analysis. Results: There were 851 patients included in the study; the average age was 38.50 ± 14.78 years. Successful PCN installs were achieved in 96.1% of cases, 67 patients had to go through multiple trials. Complications occurred in 18.9% of cases, mostly mild (17.6%), occasionally severe (1%) headaches. The most common complications were macroscopic hematuria (6.9%), PCN dislodgment (1.9%), and block the tube (1.8%). Statistical analysis showed associations between complications and demographic factors, such as age, gender, number of attempts. Conclusion: Ultrasound-guided percutaneous nephrostomy (PCN) is safe and effective in the treatment of obstructive uropathy. These findings contribute to improving treatment protocols and procedural guidelines at the Institute of Kidney Diseases, Peshawar, with urinary stones as the main etiology.

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.

Training ultrasound-guided percutaneous nephrostomy technique with porcine model.

There is increasing interest in the use of ultrasound for endoscopic and percutaneous procedures. Access can be achieved without radiation exposure under ultrasound guidance. Our aim was to develop a porcine-based training model for ultrasound-guided percutaneous renal access that could also be personalized to a specific patient. The Institutional Animal Care and Use Committee of Severance Hospital approved the study protocol. An anesthetized pig was placed in the dorsal lithotomy position. For the nephrostomy puncture, a Chiba biopsy needle with an echo tip was used under ultrasound guidance. Eight residents and three consultants in urology participated. Puncture time was defined as the nephrostomy time to confirm the flow of irrigation via the needle. After training, satisfaction survey results for clinical usability and procedural difficulty were evaluated. The 5-point Likert scale satisfaction survey for clinical usability and procedural difficulty found mean results of 4.64 and 4.09 points, respectively. There were no differences between residents and consultants for either variable. For all participants combined, there was a significant difference for nephrostomy time between the first and second trials (278.8±70.6 s vs. 244.5±47.0 s; p=0.007). The between-trial difference was greater for residents (291.5±71.2 s vs. 259.1±41.9 s; p=0.039). The difference for the consultant was not significant (245.0±69.4 s vs. 205.7±42.5 s; p=0.250). We developed a porcine-based ultrasound-guided nephrostomy puncture training model. Satisfaction survey results indicated high clinical usability and procedural difficulty. For nephrostomy time, the model was more effective for urology residents than for consultants.

Ultrasound-guided percutaneous nephrostomy: Analysis of early complications in a prospective descriptive cross-sectional study at a tertiary care center

Background: Percutaneous nephrostomy (PCN) is a crucial intervention for urinary obstruction. Understanding indications, complications, and materials used enhances its clinical application. Objective: This study aims to identify PCN indications, assess tube types/materials, evaluate early complications, and determine PCN success rates, fostering improved outcomes and procedural refinement. Materials and Methods: This study was carried out in the interventional radiology suite of the Department of Radiodiagnosis and Imaging, Tribhuvan University Teaching Hospital (TUTH) on 74 patients for one year. Patients of all age groups who underwent PCN were included in the study. Indications for PCN were identified before the procedure using various imaging modalities like Ultrasonography (USG), Computed Tomography (CT) scan, and more. The type of approach, calyx punctured, the size of the tube chosen, and the type of the drain material were all recorded during the procedure or in the post-procedure note. The patients were evaluated daily, and USG was done in every patient after 48 hours of the procedure to evaluate in terms of any complications. Results: Ninety-eight PCNs were done on 74 patients, of whom 58 were males and 40 were females. The main reasons for PCN were calculus disease with hydronephrosis (44.9%), calculus disease with pyonephrosis (22.4%), and obstructive uropathy due to bladder or cervix carcinoma. The success rate for PCN on the first attempt was 89.8%, while 6.1% required two attempts and 4.1% needed more than two attempts. Complications included tube dislodgement (8.2%), urinoma (5.1%), major bleeding (3%), and retroperitoneal hematoma (1%). No new cases of sepsis occurred post-procedure. Conclusion: Percutaneous nephrostomy is a safe and simple procedure with low morbidity and no life-threatening complications.

Application of ultrasound-guided percutaneous nephrostomy in the treatment of a solitary kidney with hydronephrosis due to renal tuberculosis

PurposeTo investigate the value of ultrasound-guided percutaneous nephrostomy and nephrostomy tube replacement for treating a solitary kidney with hydronephrosis due to renal tuberculosis.MethodsClinical data of patients with a solitary kidney with hydronephrosis caused by renal tuberculosis who underwent ultrasound-guided percutaneous nephrostomy in our hospital from January 2011 to December 2022 were retrospectively analyzed. The associated success rate and complications were statistically analyzed, pre- and post-catheterization changes in serum creatinine and blood urea nitrogen levels were compared, success rate and complications of nephrostomy tube replacement in patients with long-term catheterization were statistically analyzed, and the impact of long-term catheterization on patient life was investigated.ResultsOverall, 32 patients aged 17–75 years (average age: 44.1 ± 16.9 years) underwent ultrasound-guided percutaneous nephrostomy. Sixty-three punctures were performed; the puncture success rate was 100%. The levels of serum creatinine and blood urea nitrogen of patients decreased after catheterization, and the differences between the pre-catheterization and post-catheterization were significant (P < 0.05). There were 1, 3, and 12 cases of serious, minor, and fistula-related complications, respectively. The mean duration of the indwelling catheter was 56.7 ± 36.2 (range, 13–120) months. The number of nephrostomy tube replacements was 344 times, and the success rate was 100%. All patients could take care of the puncture point by themselves.ConclusionUltrasound-guided percutaneous nephrostomy and nephrostomy tube replacement have a high success rate and few complications, which can improve the renal function of patients. It is of great value for treating a solitary kidney with hydronephrosis caused by renal tuberculosis.

The Current State of Knowledge Regarding the Use of Double J Catheters in Treating Obstructive Urolithiasis

"Urinary lithiasis is a common pathology in the modern era. Its significance lies in the possible complications that may arise as well as in its potential for recurrence. The treatment and prevention of recurrences of urinary lithiasis often require the intervention of several specialists: urologists, nephrologists, endocrinologists, nutritionists, biochemists, etc. In the last 20 years, the treatment strategy for urinary lithiasis has changed, with minimally invasive methods replacing laparoscopic or open surgery. These are effective and have rare complications. Whichever treatment method is chosen, it may be necessary to temporarily divert the upper urinary tract by inserting double J catheters for preventive, curative, or palliative purposes. Ureteral catheters have had to be improved over time to avoid two major incidents: their migration and colonization. Various materials were used, varying the shape, size, length, guide as well as approaches. The urinary infection-urolithiasis association is frequent, without always being able to specify the cause-effect relationship. The rate of urinary colonization appears to be influenced by the presence of stent colonization as well as the time since the implant. The association of chronic diseases or emergency insertion is associated with an increased risk of urinary colonization. Complications induced by the time of the double J catheter being implanted are rare, and minor and disappear with its removal. In the case of failure to insert a double J ureteral catheter, the alternative would be to perform an ultrasound-guided percutaneous nephrostomy. Double J ureteral catheter insertion is an effective minimally invasive option in the treatment of obstructive urolithiasis. "

Laparoscopic deroofing of post-renal transplant lymphoceles – A single-center observational study

Background: Lymphocele formation is the most common identifiable surgical complication of renal transplant recipients, which often requires surgical deroofing. In this retrospective study, we are determining the efficacy of laparoscopic deroofing surgery in the management of post-renal transplant lymphocele. Aims and Objectives: This study aims to determine the efficacy of laparoscopic deroofing surgery in the management of post-renal transplant lymphocele. Materials and Methods: All patients who underwent surgical deroofing for post-renal transplant lymphocele at the Institute of Kidney DISEASE and Research Center, Ahmedabad, India, between January 2016 and October 2019 were included in the study and retrospectively reviewed. Information about symptomatology, clinical features, radiological findings, preoperative drainage, ultrasound-guided percutaneous nephrostomy (PCN) diversion, intraoperative, post-operative findings, and complications were retrieved and analyzed. Results: Among the 1138 open renal transplant recipients, 28 patients developed symptomatic lymphocele (incidence 2.5%). The mean interval to develop these lymphoceles was 8 weeks (3 weeks–4 months). All 28 patients underwent laparoscopic lymphatic deroofing surgery. There were no conversions to open surgery. Overrunning of cut edges was performed in six and omentopexy in two patients, rest of the 20 patients only deroofing of lymphocele was performed. Graft PCN was placed before surgery in four patients and in two patients, percutaneous drain was placed into the lymphocele. The mean operative time was 80 min. The mean hospital stay was 3.5 days. In one case, there was an injury to the ureter intraoperatively which was repaired over a DJ stent laparoscopically. There was one case with recurrence who had a prior history of continuous ambulatory peritoneal dialysis. He was explored and perivascular lymphatics were tied and omental packing was performed. Conclusion: Laparoscopic deroofing of symptomatic lymphoceles following renal transplantation appears to be safe and effective, because it has minimal post-operative morbidity, rapid convalescence, and low recurrence rate. Laparoscopy should be considered the first-line treatment for symptomatic lymphoceles.

V05-11 LAPAROSCOPIC MANAGEMENT OF XANTHOGRANULOMATOUS PYELONEPHRITIS – COMPARISON OF TWO DIFFERENT YET SIMILAR CASES

You have accessJournal of UrologyCME1 May 2022V05-11 LAPAROSCOPIC MANAGEMENT OF XANTHOGRANULOMATOUS PYELONEPHRITIS – COMPARISON OF TWO DIFFERENT YET SIMILAR CASES Catarina Laranjo Tinoco, Andreia Cardoso, Ricardo Matos Rodrigues, Sara Anacleto, Ana Sofia Araújo, Mário Cerqueira Alves, and Emanuel Carvalho-Dias Catarina Laranjo TinocoCatarina Laranjo Tinoco More articles by this author , Andreia CardosoAndreia Cardoso More articles by this author , Ricardo Matos RodriguesRicardo Matos Rodrigues More articles by this author , Sara AnacletoSara Anacleto More articles by this author , Ana Sofia AraújoAna Sofia Araújo More articles by this author , Mário Cerqueira AlvesMário Cerqueira Alves More articles by this author , and Emanuel Carvalho-DiasEmanuel Carvalho-Dias More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002579.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Xanthogranulomatous pyelonephritis (XGPN) is a destructive form of chronic pyelonephritis with frequent involvement of adjacent organs (with abscesses and fistulas). We present a video comparison of the laparoscopic nephrectomy of two XGPN cases. METHODS: In this video we present two cases of laparoscopic nephrectomy of XGPN cases – a simpler case (patient 1) and a more complex one with the intraoperative diagnosis and repair of a pyeloduodenal fistula (patient 2). Both patients were middle-aged females with a history of urolithiasis, who presented to the emergency department (ER) with similar symptoms: flank pain and weight loss in the previous month. The computed tomography scans showed typical signs of XGPN of right kidney: an enlarged kidney with important dilation and densification of the collecting system, caused by urinary stones. The patients were admitted to the urology ward and started on intravenous (IV) antibiotics. Patient 1 was submitted to ultrasound-guided percutaneous nephrostomy and psoas drain placement and was discharged after 9 days, with both catheters and oral antibiotics. She was readmitted after 3 months for the elective right nephrectomy. Patient 2’s also had a percutaneous nephrostomy placed by the Urology team and a hepatic drain in an abscess placed by the Radiology team. The patient stayed in the hospital for 2 weeks and was discharged after drains removal. Her right nephrectomy was scheduled for 1.5 months after. The definitive treatment of this condition is surgical with nephrectomy, drainage of concomitant abscesses and removal of the involved tissues. Our video presents and compares these patients’ laparoscopic surgeries. RESULTS: The surgical time was 2 hours in patient 1 and 4 hours in patient 2, with no intraoperative complications. Patient 1 recovered quickly and was discharged after 3 days. Patient 2 was required to stay on bowel rest with a nasogastric tube placed for 3 days. She started solid food ingestion on day 5 with great tolerance and was discharged on post-operative day 8. No post-operative complications were observed. The pathology report was similar for both patients: terminal kidney with XGPN. CONCLUSIONS: Laparoscopic management of xanthogranulomatous pyelonephritis is challenging due to the loss of anatomical planes and inflamed tissues, so a systematic approach is advisable. The management of pyeloduodenal fistulas can also be made by laparoscopy, as demonstrated in our video, the first reported case of laparoscopic treatment of this kind of fistula. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e519 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Catarina Laranjo Tinoco More articles by this author Andreia Cardoso More articles by this author Ricardo Matos Rodrigues More articles by this author Sara Anacleto More articles by this author Ana Sofia Araújo More articles by this author Mário Cerqueira Alves More articles by this author Emanuel Carvalho-Dias More articles by this author Expand All Advertisement PDF DownloadLoading ...

An alveolate kidney

Rationale: Emphysematous pyelonephritis is a life-threatening infectious disease that requires early diagnosis and treatment. The disease is often misdiagnosed due to its diversity of clinical manifestations. Patient's concern: A 62-year-old woman was admitted to the emergency department following a 12-hour history of abdominal pain and dyspnea. Physical examination showed percussion pain on the right costovertebral angle. Besides, she had a history of diabetes mellitus and urinary calculus. Diagnosis: Emphysematous pyelonephritis. Intervention: The patient accepted antishock therapy, tight glucose control, and broad-spectrum anti-infective therapy. After stabilization of the general condition, an ultrasound-guided percutaneous nephrostomy was performed. Outcome: Her conditions became stable over the following days. She presented a favorable clinical course, with normalization of renal function and positive improvements in imaging findings in a month. Lessons: Early diagnosis and rapid medical management are the keys to successful treatment. CT is an important method for the diagnosis of emphysematous pyelonephritis. For patients with severe lesions, percutaneous renal drainage combined with active anti-infection should be given in time.

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.

Outcomes of Ultrasound-Guided Percutaneous Nephrostomy in Carcinoma Cervix with Upper Tract Obstruction

Cancer cervix is the fourth most common cancer and a fourth common cause of cancer mortality in women worldwide. In India, cervical cancer is the second most common cancer among women and approximately 70% of patients present at an advanced stage with one-third of them in obstructive uropathy. The present study aims to analyze the outcomes of percutaneous nephrostomy (PCN), as a urinary diversion technique, in advanced cancer cervix. All patients with advanced cancer cervix with bilateral hydronephrosis or unilateral hydronephrosis with elevated serum creatinine (> 1.4 mg/dl) who underwent PCN in the Department of Urology, JIPMER, between November 2014 and December 2016 were included in the study in a prospective manner. The change in blood urea and serum creatinine levels was estimated by paired t test. The complications were graded according to the modified Clavien classification system. A total of 368 patients underwent PCN in the study period out of which 133 were due to cancer cervix. There were no failure or intraoperative complications during the procedure. There were no deaths noted until the follow-up period of 30 days. Only two patients developed sepsis. Out of 20 (15%) patients who developed haematuria, four (20%) required blood transfusion and was self-limiting in 16 (80%) patients. Reinsertion of PCN was required in 11 patients within a month. Percutaneous nephrostomy is a safe and effective procedure in advanced cancer cervix with obstructive uropathy.

Forniceal Rupture in Neonate Masquerading as a Cystic Renal Mass

A 5-week-old full-term female with high-risk right hydronephrosis was transferred to the emergency department (ED) for tachypnea. A contrast-enhanced computed tomography (CT) study demonstrated a 9.0 cm cystic lesion in the region of the previously seen hydronephrosis (Fig. 1). Urology was consulted to rule out a cystic neoplasm, which on review of imaging was more suggestive of a contained forniceal rupture. An ultrasound-guided percutaneous nephrostomy tube drained 200 cc of urine. Culture and cytology were negative. Respiratory status markedly improved. The patient was discharged with outpatient follow to evaluate for ureteropelvic junction obstruction.

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.

Clinical study on severe infection caused by ureteral calculus in 12 patients

Objective To explore comprehensive treatment for severe infection caused by ureteral calculus. Methods The clinical data of 12 patients with severe infection caused by ureteral calculus in the Second People's Hospital of Lianyungang from January 2016 to December 2017 were reviewed.The patients cured by anti-infective therapy received one-stage surgical treatment.The patients with ineffective anti-infective therapy received one-stage cystoscopic retrograde double J tube or B ultrasound-guided percutaneous nephrostomy first, then ureteral calculus was treated. Results Two patients were cured by empirical antimicrobial agents.One patient was successfully cured by extracorporeal shock wave lithotripsy (ESWL) and the other by retroperitoneoscopic ureterolithotomy.Ten patients were not responsive to empirical antimicrobial agents.Two patients refused treatment and requested discharge from the hospital.The other 8 patients received two-stage treatment.In the stage I, cystoscopic retrograde double J tube was accomplished in 3 patients, and 5 patients were treated successfully by percutaneous nephrostomy guided by B ultrasound.In the stage II, one patient with ureter stone-street was cured by lithagogue drugs, 2 patients were successfully cured by ESWL, one patient by holmium laser lithotripsy under ureteroscope, 2 patients by ureterolithotomy and 2 patients by percutaneous nephrolithotomy by endoscopy and holmium laser. Conclusion The therapy of retrograde double J tube at cystoscopy or percutaneous nephrostomy guided by B ultrasound combined with empirical antimicrobial agents in the satae I, combined with lithotripsy according to guidelines in the stage II in treating severe infection caused by ureteral calculus have more advantage such as simple, less injury, rapid control of infection, less complication and satisfactory effect.It is an ideal method. Key words: Ureteral calculus; Urinary tract infections; Antibiotics; Double J stenting; Percutaneous nephrostomy; ESWL

The results of ultrasound-guided percutaneous nephrostomy tube placement for obstructive uropathy: A single-centre 10-year experience

The aim of this study was to determine the results of ultrasound-guided percutaneous nephrostomy tube placement performed solely by urologists. We present our relevant one decade experience in a tertiary care hospital. We evaluated technical success and complication rates of ultrasound-guided percutaneous nephrostomy tube placement for obstructive uropathy in our clinic, between December 2004 and January 2015. Data were retrieved retrospectively from patients' files. This procedure was performed by urologists and two different methods for renal access were employed: Seldinger technique and direct puncture technique. Percutaneous nephrostomy tube placement was considered successful if the tube was placed in the renal pelvis and drained urine spontaneously and adequately. Complications were classified according to the Guideline of Society of Interventional Radiology Guidelines for Percutaneous Nephrostomy. Four hundred and fifteen percutaneous nephrostomy tube placements were performed in 354 patients (165 men and 159 women) suffering from obstructive uropathy due to several benign (57.3%) or malign (42.7%) diseases. The mean age in this study group was 43.2 years (range 27 to 81). We were found that 228 procedures were performed by using the Seldinger technique and 187 using direct puncture technique. The overall technical success, major and minor complications rates were 96.1%, 11.1%, and 7.7%, respectively. The Seldinger technique and direct puncture technique were compared: technical success rate was 97.8% vs. 94.1% (p=0.052). There was no difference between the two techniques in terms of major and minor complication rates. Ultrasound-guided percutaneous nephrostomy tube placement is a safe, easy and effective technique for providing temporary or permanent drainage of an obstructed renal pelvi-calyceal system. This procedure can be performed effectively and safely by an urologist.

Ultrasound guided percutaneous nephrostomy: Experience at ahmadu bello university teaching hospital, Zaria.

Obstructive uropathy is a common problem in urologic practice; temporary relief of obstruction in the upper tract poses a significant challenge. Ultrasound-guided percutaneous nephrostomy (PCN) is an option for upper tract drainage; compared to fluoroscopic guidance, it is readily available, affordable, and not associated with radiation exposure. We present our experience with ultrasound-guided PCN. We studied all patients who had ultrasound-guided PCN in our center between January 2013 and January 2017. Information obtained included the patients' demographics, clinical details, primary pathology, indications, outcome, and complications within 30 days. Relevant data were extracted and analyzed using descriptive statistics. A total number of 35 PCNs were performed in 26 patients within the period of study. The median age was 44.5 years. There were 17 females and 9 males. About 88.2% of the females had ureteric obstruction from advanced carcinoma of the cervix while the predominant cause of obstruction in the males was advanced carcinoma of the bladder. Kidney access under ultrasound guidance required well dilated collecting systems for success and ease of puncture. The most common complication was hematuria, which resolved within 24-48 h in all patients uneventfully. PCN is an important and common procedure for temporary relief of upper urinary tract obstruction. While fluoroscopic guidance provides superior image guidance, ultrasound guidance is comparatively reliable, albeit with a longer learning curve. Adequate training, careful patients selection, and patience are key to success.

Ultrasound-Guided Percutaneous Nephrostomy: How to Select Technique?

Ultrasound-Guided Percutaneous Nephrostomy: How to Select Technique?

Ultrasound-Guided Percutaneous Nephrostomy Performed on Neonates and Infants Using a "14-4" (Trocar and Cannula) Technique.

Percutaneous nephrostomy (PCN) catheters are placed under combined ultrasound and fluoroscopic guidance in the interventional radiology suite and present unique challenges in neonates and infants. The purpose of this study was to demonstrate feasibility of PCN using a "14-4" (trocar and cannula) technique on neonates and infants. Between September 2009 and June 2014, data for 27 kidneys from consecutive 22 neonates or infants who underwent PCN catheter placement using the "14-4" technique were retrospectively analyzed. The median age at the time of placement of the PCN catheters was 11 days (range 5-300 days). There were 18 males and 4 females. All procedures were performed in the interventional radiology suite but without using fluoroscopy. Unilateral PCN was performed on 17 out of 22 patients, while bilateral drainage was performed on five patients. The technical success rate was 100%. The median duration of PCN catheter was 75 days (range 10-138 days). Minor macroscopic hematuria not requiring blood transfusion was present in two of the patients in which the hematuria lasted in 2 days. Placement of PCN catheters using a "14-4" technique with ultrasound as the sole imaging modality is a technically feasible and desirable option for neonates or infants. The technique obviates the need for ionizing radiation and potentially could be performed in the ultrasound room or even at the bedside.

Role of ultrasound-guided percutaneous antegrade pyelography in malignant obstructive uropathy: A Nigerian experience.

Ultrasound-guided percutaneous nephrostomy of the renal pelvis is a technique that is widely acceptable especially when contrast media is introduced in the procedure of antegrade pyelography. It is a relatively safe procedure that effectively improves renal function in obstructed kidneys. It can be performed in most cases as an alternative to retrograde pyelography. We present our experience and its role in obstructive uropathy due to malignancy.