Percutaneous nephrostomy by direct puncture technique: An observational study

Abstract

Percutaneous nephrostomy is the procedure of establishing a temporary drainage tract of the renal pelvi-calyceal system through the skin. This study aims to find out whether low cost trocar catheter can be a suitable substitute for the relatively high cost fluoroscopy/ultrasonography guided tract dilatation and tube insertion procedure. Percutaneous nephrostomy by the trocar catheter was performed in 126 patients. Under local anesthesia, a stab wound deep enough to traverse the muscle layer was made through which the trocar - catheter drainage set was inserted under ultrasonography guidance. About 179 procedures were performed in 126 patients. Primary technical success rate was 94%, major complication rate 1.6%, minor complication rate 11% and catheter related complications like catheter blockage or dislodgement were 13%. There was no procedure related mortality in our series. The ultrasonography-guided trocar, catheter nephrostomy, is a quick, safe and low cost procedure in selected cases of upper urinary tract obstruction. The primary technical success and complication rates are comparable to any other reported procedure and its low cost is particularly suitable for developing countries like India.

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

“…[1] As two valid treatment options, retrograde placement of ureteral catheter or nephrostomy tube is indicated temporarily till definitive treatment of potentially life-threatening obstruction is achieved, or permanently cases where treatment is not possible. [2] In cases where advancement of ureteral catheter proximal to the obstruction is not technically feasible or not appropriate even if feasible, placement of a percutaneous nephros-tomy tube is an ideal urinary diversion method. [2] Probably in many countries, ultrasound-guided percutaneous placement of nephrostomy tube has been realized by radiologists, and nearly all studies demonstrating technical success, and complication rates have been performed by radiology clinics.…”

Percutaneous puncture of renal calyxes guided by a novel device coupled with ultrasound

“…Previously, Agostini et al ( 11 ) reported that the time to place a percutaneous nephrostomy catheter was 7 to 15 minutes. Karim and colleagues ( 6 ) reported a longer time, 39 (25-55) minutes, to perform the same procedure. In our study, the time required to perform three punctures in each kidney was 14.4 minutes with the Punctiometer and 22.4 minutes without the Punctiometer, representing mean times of 4.8 minutes and 7.5 minutes per calyx in both Groups, respectively.…”

“…The most common complications of renal puncture accessed percutaneously are unintentional perforation of abdominal organs or pleura, and bleeding from renal or the great vessels. Although the risk of complications is small ( 6 , 13 , 14 ), the risk is higher when there is minimal or no dilation of the excretory system. In the present series, we observed no organ or pleura perforation and no bleeding arising from the great vessels; our complications were limited to renal bleeding.…”

“…Furthermore, the procedure is often performed using fluoroscopic guidance, which exposes the surgeon and patient to radiation ( 4 ). The procedure can also be performed using ultrasound ( 5 , 6 ), with the advantage of avoiding radiation but the disadvantage of requiring the presence of an ultrasound expert.…”

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

“…Percutaneous needle puncture of the renal pelvis for antegrade pyelography is a technique that is widely accepted and can be performed in most cases as an alternative to retrograde pyelogram. 2 3 …”