Manipulation of the Tenckhoff catheter under fluoroscopic guidance is a useful procedure in patients who undergo chronic ambulatory peritoneal dialysis (CAPD). We reviewed 50 manipulations in 28 patients. There were no significant complications attributable to the procedure. Ten per cent of the manipulations were performed for visceral pain, 40% for malfunction within the first two weeks of catheter placement, and the remaining 50% for malfunction after two weeks of adequate dialysate flow. Overall, an initial success rate of 88% was recorded, and, after long term study, a durable success rate of 58% was demonstrated. Early malfunction (i.e., within the first two weeks) is a more ominous prognostic indicator than previously realized, with only 30% of these manipulations ultimately succeeding vs. 60% of manipulations in late onset catheter failure. Nevertheless, at least one attempt is warranted in manipulation of a malfunctioning Tenckhoff catheter.

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In 224 patients, renal stones were removed from the urinary tract using either direct extraction with a basket or forceps (59 patients), ultrasonic lithotripsy (164 patients), or infusion chemotherapy (one patient). Residual stone fragments were present more frequently in patients treated with ultrasonic lithotripsy (27%) than with direct extraction (5%). Other complications included hemorrhage (eight patients), catheter dislodgement (four patients), large amounts of urine extravasation (three patients), glycine ascites (three patients), infection (two patients), pneumothorax (one patient), and a prolonged ileus (one patient). More complications occurred among the first 50 patients than the last 50 patients, even though more difficult cases, including patients with staghorn calculi, were accepted during the latter period. Although a learning curve exists, complications can be minimized by attempting to treat more favorable cases during the initial experience.

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