Nonvascular Interventions of the Urinary Tract

Abstract

Nonvascular intervention of the urinary tract is a well-established uroradiologic subspecialty, which is more important for avoiding invasive open surgery in the age of rising demand about the value of less invasive treatment. Various kinds of nonvascular intervention are recently performed under image-guidance and are as follows: percutaneous nephrostomy, percutaneous nephrostolithotomy, percutaneous dilatation of the urinary tract, sclerotherapy for renal cysts, percutaneous catheter drainage, percutaneous foreign body retrieval and biopsy. Percutaneous nephrostomy is a basic technique to provide a direct access to urinary tract, which makes it possible to perform other interventional procedures. Although nonvascular intervention may produce some complications, it is generally considered to be less invasive than open surgery and has advantages such as short hospital stay, early return to normal life and therefore economic savings. This review is described to help clinicians easily understand the procedures, indications, techniques, and complications with figures of cases the authors experienced.

Use of locking-loop pigtail nephrostomy catheters in dogs and cats: 20 cases (2004–2009)

“…The latter was considered unlikely because this procedure is typically considered to cause minimal renal damage. [24][25][26] Catheter placement was associated with short procedure times in the present study. Unfortunately, documentation of the exact duration of catheter placement was not available in the anesthesia record when the catheters were placed during another definitive procedure, which included most cases.…”

“…24 Since that time, the type of catheter considered standard of care, the safest, and most effective is the locking-loop PNC. [24][25][26] In people, these catheters can be left in place long term, provided careful maintenance and routine catheter exchanges are performed. The overall major and minor complication rates associated with PNCs in people are 3% to 8% and 3% to 25%, respectively, with complications including hematuria, infection, dislodgement, pneumothorax or hemothorax, intestinal injury, septicemia, and urine leakage.…”

Interventional Radiology and the Care of the Oncology Patient

“…Management requires urinary decompression, often by means of percutaneous nephrostomy (PCN). PCN is the most common renal intervention performed by IR and, by providing direct access to the urinary tract, allows drainage of tract contents as well as providing access for further uroradiologic intervention via the route established [ 70 ]. Indications for PCN in the emergent setting include urinary tract sepsis, pyonephrosis, deteriorating renal function, or electrolyte disturbances such as hyperkalemia and metabolic acidosis [ 8 ].…”

“…The size and type of the drainage catheter should be chosen appropriately according to the nature of the fluid to be drained [ 70 ]. In cases of malignant ureteric obstruction, when retrograde stenting is unsuccessful or not feasible, percutaneous dilatation of the stricture may be achieved antegradely through the PCN tract where, under fluoroscopic guidance, a catheter is manipulated across the stenotic region and the lesion is progressively dilated by catheter advancement, ureteral dilator, or by inflating balloons of appropriate diameter and length [ 70 ]. After dilatation, an internal ureteral stent, or internal-external nephroureteral catheter is placed to prevent restenosis [ 70 , 72 ].…”