Transient ultrasound-guided percutaneous nephrostomy is kidney saving procedure

This study was conducted to present the outcome of the transient ultrasound-guided percutaneous nephrostomy [US-PCN] as a kidney saving procedure in cases with obstructive uropathy with or without ipsilateral infection. Between Jan 2000 and Jan 2009, 1283 transient percutaneous ultrasound-guided nephrostomy [unilateral or bilateral] were performed for 1105 patients. Patients were classified into three groups according to the main indications of PCN insertion. Group-I; 427 patients were suffering of obstructive uropathy and impaired renal function. In group-II, 522 PCN was performed for 516 patients with acute renal failure due to non-malignant obstructive uropathy. While in group-Ill, 162 patients with either pyonephrosis or infected hydronephrosis were urgently needed PCN drainage. The mean age was 51 +/- 4 years old [range: 16-87 years old], 852 males [77.1%] and 253 females [22.9%]. Two techniques were used to achieve the proper drainage; the one-shot for clear urine or Seldinger for cases with turbid urine. Transient unilateral US-PCN was inserted in 927, while the other 178 cases nephrostomy were bilaterally [356] performed. Significant improvement was determined in 79% of the patients [P<0.005] one month after drainage and they scheduled for definitive management. The mean serum creatinine of all patients was significantly dropped [P<0.01] from 4.7 mg/dL to 1.3 mg/dL after one month of the renal drainage. Ultrasound-guided percutaneous nephrostomy was achieved without major complications in all patients apart of 3 cases with severe bleeding and 8 patients developed acute pyelonephritis. Transient PCN is a reliable, rapid, mostly easy, and effective method to save the kidney and it associated with low complications rate

role of unenhanced helical computed tomography scan in the diagnosis of acute renal colic

Patients presenting in the emergency room [ER] with flank pain suggestive of renal or ureteric stones may have alternative underlying conditions mimicking urolithiasis. An early diagnosis and appropriate treatment for urolithiasis and other causes of flank pain is important. The majority of centers around the world are increasingly using un-enhanced helical CT [UHCT] for evaluation of renal colic. This study was conducted to define the importance of UHCT as an alternative to US and IVP in cases of acute renal colic with suspected renal or ureteric stones as a cause of pain and to define the incidence and spectrum of significant incidental diagnosis other than renal or ureteric stones. 43patients presented at ER with acute loin pain were reviewed with UHCT for suspected renal or/ureteral stones. Radiological diagnosis of clinical entities not suspected otherwise was analyzed. All other relevant radiological, biochemical and serological investigations and per-operative findings were also noted. Renal stones were identified in 11 patients [25.6%], ureteral calculi were identified in 16 patients [37.2%], findings of recent passage of calculi in 2 patients [4.7%] and no calculi in 14 patients [32.5%]. Overall the incidental findings [additional or alternative diagnosis] were found in 3 [6.9%] CT scans of all patients; and [21%] of nonurinary calcular patients. Diagnosis was confirmed by peri-operative findings, and other radiological and biochemical investigations or on clinical follow up. UHCT is more beneficial than US and IVP in ER for accurate and rapid management of cases of acute renal colic as a wide spectrum of significant incidental diagnosis - other than stones - can be identified on UHCT performed for suspected renallureteral stones. In the present series of 43 CT examinations, Urolithiasis was appeared in 67.5% of cases. The incidence of incidental diagnosis of pathologies other than urolithiasis was 6.9% of all patients 21% of patients with no calculi