Komplikationen bei perkutaner Nephrostomieeinlage

Objective: We evaluated the effectiveness of the subcutaneous bypass for ureteral obstruction in patients with advanced malignancies. Two versions of the minimally invasive technique were performed: nephrovesical and nephrocutaneous bypass. Methods: A specially designed composite implant consisting of an inner smooth silicone-covered tube covered by a coiled e-PTFE-tube was used in 14 patients. Results: 10 subcutaneous nephrovesical bypasses were inserted in 10 patients, 8 nephrocutaneous bypasses in 4 patients. During the mean follow-up period of 13.1 months complications were observed in 2 patients with nephrocutaneous bypass, one encrustation and one infection of the bypass system. Conclusions: The subcutaneous nephrovesical and nephrocutaneous bypass is a safe alternative for palliative treatment of ureteral obstruction caused by pelvic malignancy.

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“…Compared to endoluminal stents, permanent nephrostomy carries a higher rate of complications (i.e. bleeding, infection) [1][2][3][4] .…”

Section: Discussionmentioning

confidence: 99%

“…This procedure, and more so bilateral nephrostomy, impairs the patient's quality of life [1][2][3][4] . On the other hand, untreated bilateral ureteral obstruction results in uremia.…”

Section: Introductionmentioning

confidence: 99%

Subcutaneous Nephrovesical and Nephrocutaneous Bypass

Jurczok

Loertzer²,

Wagner³

et al. 2005

Gynecol Obstet Invest

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“…A transfusion was needed because of the percutaneous approach for only 8 patients (2.9 %); usually transfusion was necessary because of low hemoglobin levels before the procedure rather than because of the procedure itself. Serious complications that usually accompany percutaneous access to the kidney, such as sepsis, severe bleeding, 2 or injury to adjacent organs, 3 were not experienced with our technique. We initially failed to access the collecting system in 7 patients (2.5 %), mainly because of anatomic difficulties or lack of patient cooperation.…”

Section: Resultsmentioning

confidence: 95%

Percutaneous Nephrostomy in Patients with Tumors of Advanced Stage: Treatment Dilemmas and Impact on Clinical Course and Quality of Life

Aravantinos

Anagnostou

Karatzas

et al. 2007

Journal of Endourology

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Despite the fact that percutaneous nephrostomy has shown good safety characteristics and beneficial impact on renal function, only patients with specific cancers most likely to respond to ongoing palliative therapy or with cancers that progress slowly by nature may statistically benefit from the procedure. This questions the universal application of this procedure for all types and stages of advanced malignancy.

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“…Diese Art der Harnableitung wird als unkomfortabel empfunden und schlecht toleriert [7,8,19,20].Als Gründe werden Katheterkomplikationen (wie z. B. Dislokationen oder Okklusion) und die häufig kurzen Wechselabstände angegeben [8,19].Weiterhin findet man im Vergleich zur inneren Harnableitung eine höhere Komplikationsrate (z.B.Blutungen oder Infektionen) [20].…”

Section: Diskussionunclassified

“…Die perkutane Nephrostomie muss oftmals als Dauerlösung zur palliativen Harnableitung bei maligner Ureterkompression eingesetzt werden.Insbesondere wenn beiderseits eine Nephrostomie eingelegt werden muss,geht dies mit einer erheblichen Einschränkung der Lebensqualität des Patienten einher [7,8,19,20]. Andererseits führt eine unbehandelte beidseitige Ureterobstruktion unweigerlich in die Urämie.…”

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