Percutaneous nephrostomy for assessment of functional recovery of obstructed kidneys

Pode, Dov; Shapiro, Amos; Gordon, Roy L.; Lebensart, Pinchas D.

doi:10.1016/0090-4295(82)90603-3

Cited by 24 publications

(13 citation statements)

References 9 publications

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“…It is well established that temporary PCN drainage in infected kidney of younger children leads to high renal recovery. [23][24][25][26] The duration of PCN was 6 weeks in present study. Pode et al showed that 4 weeks is sufficient enough for renal recovery.…”

Section: Discussionmentioning

confidence: 67%

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Clinical profile and outcome of pelvi-ureteric junction obstruction (PUJO) in children presenting above 1 year

Pramod

Ramji

2018

Int Surg J

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Background: Pelvi-ureteric junction obstruction (PUJO) is defined as anatomical or functional obstruction to the flow of urine from the pelvis to the upper ureter. With the advent of ultrasonography most of the cases of PUJO are identified in antenatal period. The treatment protocol for antenatal diagnosed PUJO is standardized. Few children present later in life. Present study was done to evaluate clinical profile and outcome of children presenting with PUJO above 1 year.Methods: A retrospective observational study conducted by the department of Paediatric Surgery, KIMS hospital Bangalore. All children with PUJO above 1 year of age from January 2015 to January 2018 were included. Clinical, biochemical and imaging findings of these children were tabulated. A diuretic renogram was done to confirm the diagnosis. The children underwent either pyeloplasty or nephrectomy, depending on the function of the kidney. In children with calculi, pyelolithotomy with pyeloplasty was done. The children were followed up post-surgery.Results: Twenty-six children were included in the study. Mean age of presentation was 6.86±4.13years. Most common presentation was pain abdomen. Left kidney was commonly involved. The mean anteroposterior pelvic dimension (APPD) of involved kidney was 38.96±17.7 mm. 5 children presented with poorly functioning kidney with split renal function less than 10%. In three children PUJO was associated with pelvic calculi. Out of the 26 children simple nephrectomy was required in 4 (15%) children. The remaining 22 children underwent pyeloplasty. Mean duration of stay was 6.19±1.8 days. Post-pyeloplasty diuretic renogram showed improved drainage with improved function.Conclusions: PUJO is common cause of urinary obstruction in children. Delay in diagnosis or presentation leads to increased chances of renal damage and loss. Hence it is important to diagnose PUJ obstruction at the earliest and receive prompt treatment.

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Section: Discussionmentioning

confidence: 67%

“…Pode et al showed that 4 weeks is sufficient enough for renal recovery. 26 The two children in whom kidney improvement failed post PCN were of older age (12 years).…”

Section: Discussionmentioning

confidence: 99%

Clinical profile and outcome of pelvi-ureteric junction obstruction (PUJO) in children presenting above 1 year

Pramod

Ramji

2018

Int Surg J

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“…Percutaneous nephrostomy was first described in 1955 by Goodwin et al for relief of an obstructed kidney and became a widely accepted procedure in children in the 1980s. 9,10,11,12 . Some reports in the 1980s described the use of PCN as an easy and safe procedure to determine the recoverability of renal function in obstructed kidneys (13) with a high technical success rate (88-99%) and a low complication rate (4-8%) (14,15) .…”

Section: Discussionmentioning

confidence: 99%

Outcome of Percutaneous Nephrostomy in Children With Ureteropelvic Junction Obstruction

Chowdhury¹,

Zaman²,

Rasul³

et al. 2020

Bang J Urology

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Introduction and objectives: Congenital ureteropelvic junction obstruction (UPJO) is the most common cause of hydronephrosis. Management protocols are based on the presence of symptoms and when the patient is asymptomatic the function of the affected kidney determines the line of treatment. Percutaneous nephrostomy (PCN) became a widely accepted procedure in children in the 1990s. The aim of the study was to evaluate the results of performing percutaneous nephrostomy (PCN) in all patients with UPJO and split renal function (SRF) of less than 10% in the affected kidney, because the management of such cases is still under debate. Methods:This prospective clinical trial was carried out at Dhaka Medical College Hospital from January 2014 to December 2016. Eighteen consecutive patients who underwent PCN for the treatment of unilateral UPJO were evaluated prospectively. In these children, ultrasonography was used for puncture and catheter insertion. Local anesthesia with sedation or general anesthesia was used for puncture. Pig tail catheters were employed. The PCN remained in situ for at least 4 weeks, during which patients received low-dose cephalosporin prophylaxis. Repeat renography was done after 4 weeks. When there was no significant improvement in split renal function (10% or greater) and PCN drainage (greater than 200 ml per day) then nephrectomies were performed otherwise pyeloplasties were performed. The patients were followed up after pyeloplasty with renograms at 3 months and 6 months post operatively. Results: All the patients had severe hydronephrosis during diagnosis and 14 patients with unilateral UPJO were improved after PCN drainage and underwent pyeloplasty. The rest four patients that did not show improvement in the SRF and total volume of urine output underwent nephrectomy. In the patients with unilateral UPJO who improved after PCN drainage, the SRF was increased to 26.4% ±8.6% (mean± SD) after four weeks and pyeloplasty was performed. At three and six months follow-up, SRF value was 29.2% ±8.5% and 30.8.2% ±8.8% respectively. Conclusion: Before planning of nephrectomy in poorly functioning kidneys (SRF < 10%) due to congenital UPJO, PCN drainage should be done to asses improvement of renal function. Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.61-64

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“…There is debate regarding the duration of PCN drainage for evaluation of renal function. Pode et al, (1982) reported functional recovery in 2 of 4 adult kidneys after PCN drainage and recommended a minimum of 4 weeks of drainage to assess recoverability. In another study the optimal period of drainage before maximal recovery was described as two months (Kerr, 1956) 7 .…”

Section: Fig 4: Overall Changes In Gfr Following Pcn (N = 57)mentioning

confidence: 99%

“…Congenital UPJ obstruction is the most common cause of hydronephrosis in children but not uncommon in adults.The management of hydronephrosis with poor renal function has been the subject of debate.Clinically some kidneys with <10% split renal function become difficult to interpret whether corrective surgery or nephrectomy is needed 1 . In the presence of obstruction, poor or absent renal function on the intravenous urogram or DTPA renogram may not give a clear idea about the reasonable functional recovery of the kidney 2,3 . In this circumstance, percutaneous nephrostomy relieves obstruction and some time gives renal functional recovery in some cases.…”

Section: Introductionmentioning

confidence: 99%

Functional Outcomes After Percutaneous Nephrostomy in Hydronephrotic Kidneys in Adult Population

Hossan¹,

Naser

Khan

et al. 2020

Bang J Urology

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Objective: To evaluate the results of renal function after percutaneous nephrostomy in hydronephrotic kidneys in adult population. Methods: This study was performed on 57 patients of more than 18 years of age with hydronephrosis due to PUJ obstruction and split renal function <10% at the Department of Urology, Dhaka Medical College Hospital. Patients with concomitant pathologies like stone, pyonephrosis and VUJ obstruction were excluded from the study. Their evaluation included split renal function (SRF),glomerular filtration rate (GFR),specific gravity of urine draining through nephrostomy tube,volume of urine through nephrostomy tube. Statistical analysis was performed by SPSS version 13 and the test statistics used to analyse the data were descriptive statistics and Repeated measure ANOVA. Results: Mean age of the patients was 33.4+13.0 years, mean SRF increased from 6.2% at baseline to 18.6% after 6 weeks of PCN (p < 0.001), mean GFR increased from 6.2 ml/min/1.73 sq-meter at baseline to 18.6 ml/min/1.73 sq-meter at the end of week 6,mean specific gravity of urine significantly increased from 1.009 at baseline to 1.019 after 6 weeks, volume of urine at 2nd week was 316 ml/ 24 hours and nearly 363 ml/ 24 hours after 6 weeks of PCN (p < 0.001).GFR and SRF improved in 78.95% case Conclusions: Most of the poorly functioning hydronephrotic kidneys showed functional improvement following PCN and hence not all such kidneys should be removed without subjecting them to a trial of PCN. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.93-97

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Percutaneous nephrostomy for assessment of functional recovery of obstructed kidneys

Cited by 24 publications

References 9 publications

Clinical profile and outcome of pelvi-ureteric junction obstruction (PUJO) in children presenting above 1 year

Clinical profile and outcome of pelvi-ureteric junction obstruction (PUJO) in children presenting above 1 year

Outcome of Percutaneous Nephrostomy in Children With Ureteropelvic Junction Obstruction

Functional Outcomes After Percutaneous Nephrostomy in Hydronephrotic Kidneys in Adult Population

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