Ultrasound-Guided Percutaneous Nephrostomy: How to Select Technique?

Abstract

Introduction: Ultrasound guided percutaneous nephro stomy (PCN) is a safe and effective treatment option for obstructive uropathy. Several techniques have been described in documents. However, the recommendation of PCN technique has not been proposed. Aim:To determine the success and complication rates of ultrasound guided PCN. Meanwhile, we attempt to determine a baseline value in order to orient surgeon to select an optimal technique preoperatively. Materials and Methods:This was a retrospective study conducted at Department of Urology of the First People's Hospital of Yueyang City, China. Total 150 PCNs under ultrasound guidance were analyzed. Two puncture techniques were used. In Seldinger technique (ST), ultrasoundguided puncture needle was inserted into the calyx; a drainage catheter was placed following the guide wire. In onestep technique (OT), the drainage catheter set was inserted directly into the collecting system under ultrasound guidance.Statistical Analysis: A statistical analysis was performed using the SPSS software package (versions 19.0). Results:Total 53 PCNs were performed using Seldinger technique, and 97 PCNs were performed using onestep technique. The ST group had higher technical success rate (100% vs 87.6%, p =0.008). The ST group also obtained higher success rate in <3 cm hydronephrosis subgroup (100% vs 44.4%, p<0.05). The success rate in ≥3cm subgroup was similar (100% vs 97.5%). The overall complication rate was 15.1% in ST group and 43.3% in OT group (p<0.05). The major complication rate was 1.9% vs. 13.4% (p<0.05). The minor complication rate was 13.3% vs 29.9% (p<0.05). Conclusion:Ultrasoundguided PCN is an effective and safe treatment method for obstructive uropathy. The Seldinger technique can effectively achieve success in all possible situations and is superior to the onestep technique when hydronephrosis is <3cm. Onestep PCN is an effective and safe procedure in selected patients with hydronephrosis ≥3cm. We recommend 3cm of hydronephrosis should be an acceptable baseline for technique selection.