ABSTRACT
The aim of this study was to present our experience in using a modified double-puncture technique for percutaneous nephrostomy [PCN] of nondilated renal collecting systems under ultrasound [US] guidance without using fluoroscopy. Over a 6-years period, 35 patients [42 kidneys] without calyceal dilatation at US who required nephrostomy drainage were studied. Twenty-five patients [30 kidneys] had ureteral leaks or fistulas, six patients [7 kidneys] had ureteral injuries after gynaecologic surgery, two patients [3 kidneys] had acute nondilated renal failure and two cases had PCN for extraction of ureteral stents [2 kidneys]. Mean age was 47.5 years [range, 18-68 years]; 26 patients were men and nine were women. A modified double apuncture technique was used under ultrasound guidance. After intravenous administration of frusemide to allow visualization and distention of the nondependent calyces for definitive renal access, a 22-gauge needle was inserted into the renal pelvis, and an 18-gauge 5-F sheath-needle set was used to puncture the desired calyx and a hydrophilic wire was introduced. After serial dilation, a nephrostomy catheter was inserted. Success and major complication rates were studied. Catheter placement was successful in 40 [95.2%] of 42 kidneys. Five patients [14.3%] developed urinary tract infection after PCN. One patient [2.8%] developed septicaemia. Drainage catheter dislodgement occurred in six cases [17.2%]. Tube blockage occurred in two cases [5.7%]. Two patients [5.7%] developed peri-renal urinomas .One patient developed severe hematuria that required blood transfusion but no further intervention was performed. The modified double-puncture technique is a simple and relatively safe procedure to fix a nephrostomy tube in the nondilated renal collecting systems with few complications