Success, Effectiveness and Safety of Combined Sonographic and Fluoroscopic Guided Percutaneous Nephrostomy in Malignant Ureteral Obstruction

Abstract

Introduction: Percutaneous nephrostomy (PCN) is a palliative procedure required to drain malignant ureteral obstruction to provide reasonable benefit to the patient. The study was conducted with the objective to assess the success, effectiveness and safety of combined USG and Fluoroscopy guided percutaneous nephrostomy in malignant ureteral obstruction.Method: 69 obstructed ureters due to malignant cause in 50 patients were drained by PCN using combined ultrasound (USG) and fluoroscopic guidance. Postprocedural renal function tests were compared to pre-procedural values using paired t-test. Percentage of correct placement of tube and complications were studied.Result: PCN was successful in 98.55% units. Significant improvement in renal function occurred in 88% patients. Mean urea dropped from 89.68mg/dl ±39.95 to 65.34±16.55 mg/d and mean S. creatinine decreased from 4.31±2.84 to 2.61±1.21 between 14-35 days. No statistically significant increase was seen in renal parenchymal thickness. Major complications developed in 4.33% while minor in 50.72% PCN's with pain being the most common complication in 17.39% cases. Conclusion:PCN was successfully performed under combined image guidance and it effectively drained the obstructed kidney. It is a safe procedure but has a high minor complication rate leading to patient morbidity.

Emergency Decompression of Obstructive Uropathy Using Percutaneous Nephrostomy: Disease Pattern and Treatment Outcome at Two Urology Centers in Ethiopia

“…Regarding the causes of OU, many literatures showed that most cases are secondary to lower urinary tract pathologies which are primarily malignant. 11,21 Our study also showed a similar finding in which more than 80% of the obstructive pathologies were caused by pelvic malignancies and the ureter was essentially the commonest part of urinary tract involved (77%).…”

“…Some studies reported image-guided PCN to be performed in males more commonly than in females while other studies showed females with OU to be commonly encountered during this procedure. 1,16,[18][19][20][21] Our study shows a female predominance (70%), which is partly explained by the finding that cervical cancer is the commonest cause of OU in this study (37.3%) and more than 50% of OU patients with bladder cancer were females. However, being male was associated with an increased likelihood of successful outcome of emergency PCN [AOR = 5.72 (1.13-28.92) at 95% CI; p = 0.035].…”

“…2,9,10 PCN is a kidney-saving and, for that matter, life-saving emergency procedure with a high success rate. 11,21 In the year 1974, Pedersen first described ultrasound-guided placement of PCN tube into an obstructed kidney and reported a success rate of 75%. 1 In the literature, many factors are mentioned as determinants of successful outcome such as degree of hydronephrosis, imaging technique used, and experience of the surgeon.…”

Complications of endourological procedures and their treatment

“…Less commonly usage of CT can be used especially in abnormal anatomy, ectopic kidney and transplanted kidney (4) Contrast enhanced US can be used in non-dilated kidneys (5). Combined use of ultrasound and fluoroscopy is expected to achieve better results in terms of success rate and decrease in the occurrence of major complications of percutaneous nephrostomy insertion (6). US alone can be used safely in PCN insertion in case of marked dilatation of pelvicalyceal system especially in one stab technique and also can be used in puncture and dilatation in cases of pregnancy or hypersensitivity to contrast material but by well experienced surgeons (3).…”