Percutaneous nephrostomy and antegrade ureteral stenting: technique—indications—complications

Hausegger, K. A.; Portugaller, Horst

doi:10.1007/s00330-005-0136-7

Cited by 164 publications

(108 citation statements)

References 50 publications

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“…Floroskopi eşliğinde PKN takılırken kılavuz tel ilerletilmesi, dilatasyon ve katater yerleştirilmesi için fluoroskopi kullanılır. Bu yöntemin dezavantajı perirenal anatominin görüntülenememesi nedeniyle komşu organ yaralanma riskidir [8]. Fluoroskopi sırasında toplayıcı sistemin görüntülenmesi için intravenöz veya retrograd kontrast madde verilmesi gerekir [9].…”

Section: Discussionunclassified

Urologist Directed Percutaneous Nephrostomy Tube Placement: 6 Years Experience

2016

Ann Clin Anal Med

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ÖzetAmaç: Kliniğimizde 6 yıl süresince perkütan nefrostomi (PKN) uygulamaları-mızı ve komplikasyonlarımızı modifiye Clavien sınıflamasına göre raporlamayı amaçladık. Gereç ve Yöntem: Kliniğimizde 722 hastaya (538 erkek ve 184 kadın) 814 PKN uygulandı. PKN uygulaması dilate sistemlerde ultrason eşli-ğinde, dilate olmayan sistemlerde ise ultrason/fluroskopi eşliğinde yapıldı.Kateterden spontan idrar gelişi başarılı olarak kabul edildi. Komplikasyon sayı-ları tescil edildi. Bulgular: PKN takılan 814 sistemin 770'inde (94.5%) başa-rı sağlanmıştır. Dilate olmayan ve dilate sistemler için başarı oranlarımız sı-rasıyla % 71.1, % 97.7 ve toplam komplikasyon oranımız %17.3 idi. Modifiye Clavien sınıflamasına göre komplikasyonlarımız derece I, II, III, IV ve V için sırasıyla % 9, % 1.2, % 6.2, % 0.3, % 0.3, % 0.4 ve % 0.1idi. Hasta yaşı, hidronefroz derecesi, serum kreatinin seviyesi ve ortalama hemoglobin düzeyi komplikasyon gelişimi açısından anlamlı risk faktörleri olarak saptandı. Ayrı-ca dilate olmayan sistemin komplikasyon oranlarını anlamlı şekilde etkilediği görüldü. Tartışma: Perkütan nefrostomi obstrüksiyona bağlı dilate sistemlerin geçici ve kalıcı tedavisinde iyi bilinen bir yöntemdir. Uygulamalara bağlı komplikasyonların tanımlanması klinik karşılaştırmaların çok daha doğru yapılması için çok önemlidir. . Modifiye Clavien sınıflaması PKN komplikasyonlarının değerlendirilmesi için kullanılabilir bir sistemdir. Anahtar KelimelerPerkütan Nefrostomi; Sonuçlar; Clavien; Komplikasyonlar Abstract Aim: To report our results on percutaneous nephrostomy (PCN) and classify our complications with the modified Clavien Classification System (CCS) in 6 years. Material and Method: Eight hundred fourteen PCN insertions were performed in 722 patients (538 men and 184 women) at our institution. PCN insertion was performed under ultrasound for dilated pelvicalyceal system and ultrasound/fluoroscopy for nondilated system. PCN was considered successful if the catheter was drained urine spontaneously. Number of complications was registered. Results: Primary successful PCN insertion was achieved in 770 of the 814 procedures (94.5%). The success rates for nondilated and dilated systems were 71.1% and 97.7%, respectively. Our overall complication rate was 17.3%. According to the modified CCS grades I, II, III, IV, and V were 9%, 1.2%, 6.2%, 0.3%, 0.3%, 0.4% and 0.1%, respectively. Age, grade of the hydronephrosis, serum creatinine levels, and mean hemoglobin levels were statistically significant parameters for the occurrence of complications. The nondilated system has statistically significant parameter affecting the complication rates. Discussion: Percutaneous nephrostomy is a well-known procedure in the treatment of temporary or permanent drainage of an obstructed system. It is very important to define the complications related to interventions for interpretation of clinical comparisons more accurately. Modified CCS is a reproducible system to evaluate the complications of PCN.

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Section: Discussionunclassified

Urologist Directed Percutaneous Nephrostomy Tube Placement: 6 Years Experience

2016

Ann Clin Anal Med

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“…But complications and morbidity of nephrostomies are high and contribute to a deteriorating quality of life. 3 On the other hand, ureteral double J stents have been widely used for internal urinary diversion for ureteral obstructions with an acceptable morbidity. Prevalence of complications such as infections, stone formation, or obstruction increases with time.…”

Section: Discussionmentioning

confidence: 99%

“…As Chang et al reported 10 and also in our experience, inflammation of bladder made the mucosa look like a battlefield and hampered visualization of the ureteral orifices, or invasion of primary tumor to ureter impeded pushing forward the double J stent or guide wire during replacement. Even though antegrade percutaneous double J stent replacement was an option in these cases, 3 high complication rates of procedure have to be kept in mind. With our simple technique, the proximal tip of the stent stays on the proximal side of the stenotic ureteral area during guidewire insertion, so we do not have to face such difficulties.…”

Section: Discussionmentioning

confidence: 99%

Manual Replacement of Double J Stent Without Fluoroscopy

Köse

Görgel

Özbir

et al. 2015

International Surgery

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It is not always possible to replace a ureteric stent with a new one due to the fact that tumoral effect increases in ureter with time. We present our experience of manual replacement of double J stent without fluoroscopy. The data from 23 female patients who underwent double J stent replacement with a total of 110 times was retrospectively analyzed. The steps of technique are as follows: take out distal end of the double J stent through urethra to external urethral meatus cystoscopically, insert a 0.035-inch guide wire through double J stent to the renal pelvis or intra pelvicaliceal system, take out old double J stent over guide wire, slide new stent over guide wire and at external meatus level take out guide wire while gently sliding distal end of double J stent over guide wire into urethra. The mean age was 58.39 6 9.21 years. Cervical, endometrial, and ovarian cancer were diagnosed in 16, 4, and 3 patients respectively. The mean follow-up and indwelling period were 13.8 6 5.2, 3.8 6 0.6 months, respectively. Increased pelvicaliceal dilatation, serum creatinine level, or renal parenchymal loss was not observed. Replacement of double J stents with this technique is easy and can be used successfully in distal ureteral obstructions.

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“…Hausegger and Portugaller [11] reported their experience with regard to insertion of percutaneous nephrostomy and placement of ante-grade ureteric stenting as follows: Percutaneous nephrostomy insertions were undertaken with ultrasound-scan/fluoroscopic guidance with a success rate of more than 90%.The complication rate was about 10% for major and minor complications together and only 4 to 5% for major complications. Hausegger and Portugaller [11] iterated that in the case of severe infection and bleeding pursuant to nephrostomy insertion, double J (JJ) stent insertion may be contraindicated as long as there is no sufficient concomitant drainage via the percutaneous nephrostomy.…”

Section: Discussionmentioning

confidence: 99%

Ante-grade ureteric stenting, retrospective experience in managing 89 patients: Indications, complications and outcome

Venyo

Hanley

Barrett

et al. 2014

JBGC

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Background: Over the past three decades there has been a remarkable increase in interventional uro-radiological procedures in the developed countries. Long-term drainage of the obstructed upper urinary tract may be achieved by percutaneous nephrostomy or ureteric stenting. Previously most ureteric stents were inserted by the retrograde approach at cystoscopy and these procedures have required the use of general or spinal anesthesia. With the development of a nephrostomy service in most hospitals throughout the world ante-grade ureteric stenting procedures are being carried out by trained interventional radiologists in the radiology department without the need for a general or spinal anesthesia. Aims/materials and methods:To review the records of all 89 patients who had insertion of ante-grade ureteric stents for ureteric obstruction between February 2010 and January 2013 in order to document the following: The causes of obstruction; The side (left, right or both sides) and site of the ureteric obstruction (upper, mid or lower ureter); The sex and ages of the patients; Success or failure of the procedure; Complications of procedure; The management of the complications.Results: Ante-grade ureteric stenting was successful in 105 out of 121 procedures (86.7%) which 89 patients underwent. Out of 105 successful ante-grade stenting procedures carried out, 103 were successful at first attempt, another two were successful at second attempt and one successful at a third attempt, making it a total of 105 successful procedures. There were minimal complications. Conclusion and recommendation:Ante-grade ureteric stenting is a safe procedure with minimal complications. Every radiology unit should have a trained interventional radiologist capable of performing ante-grade ureteric stenting.

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Percutaneous nephrostomy and antegrade ureteral stenting: technique—indications—complications

Cited by 164 publications

References 50 publications

Urologist Directed Percutaneous Nephrostomy Tube Placement: 6 Years Experience

Urologist Directed Percutaneous Nephrostomy Tube Placement: 6 Years Experience

Manual Replacement of Double J Stent Without Fluoroscopy

Ante-grade ureteric stenting, retrospective experience in managing 89 patients: Indications, complications and outcome

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