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Objective:To compare the perioperative outcomes and safety of percutaneous nephrostomy (PCN) and retrograde ureteral stenting (RUS) in the treatment of acute obstructive upper urinary tract infection.Methods:A comprehensive search was performed on the MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials to identify relevant literatures. The retrieval period was from the establishment of the database to August 2022. Inclusion criteria: ①Randomized controlled trial (RCT) of PCN and RUS in the treatment of acute obstructive upper urinary tract infection; ②Studies provided accurate data for analysis, including the total number of subjects and the results of each index; ③The full text of the study was available, and different literatures published in the same cohort were included in the newly published data. ④The observation indexes included the time for the recovery of body temperature, creatinine, leukocyte, operation, radiation exposure, postoperative fever, postoperative pain, and the incidence of postoperative fistulotomy or stent displacement. Exclusion criteria: ①non-RCT study; ②unable to obtain the full text. Two researchers independently screened the literature and evaluated the literature quality, and all the statistical data were analyzed by RevMan5.3 software.Results:Seven trials enrolled 727 patients were included in the meta-analysis, 412 in the PCN group and 315 in the RUS group included. Meta-analysis revealed that the advantages of PCN were lower incidence of postoperative hematuria ( OR=0.54, 95% CI 0.30-0.99, P=0.040) and lower incidence of insertion failure ( OR=0.42, 95% CI 0.21-0.81, P=0.010), but the fluoroscopy time of RUS group was shorter than that of PCN group ( MD=0.31, 95% CI 0.14-0.48, P<0.01). Moreover, there was no significant difference in time to normalization of temperature, time to normalization of creatinine, time to normalization of WBC, operative time, postoperative fever, postoperative pain, postoperative nephrostomy tube or stent slippage rate between the two surgical methods( P>0.05). Conclusions:The radiation exposure time of PCN was longer than that of RUS, but the incidence of postoperative hematuria and catheterization failure was lower than that of RUS.
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Objective:To investigate the management of patients with intravenous misplacement of nephrostomy tube following percutaneous renal surgery.Methods:The data of 6 patients with intravenous misplacement of nephrostomy tube during percutaneous nephrolithotomy (PCNL) treated in the two hospitals of Chenzhou from January 2006 to December 2020 were retrospectively analyzed. The median age was 41.0(38.5, 53.0) years old. There were 4 males and 2 females. Three patients had undergone contralateral upper urinary tract operation. One patient had undergone ipsilateral upper urinary tract operation. Two patients had not undergone upper urinary tract operation. Two of the 6 patients had a solitary kidney. Two patients were diagnosed with staghorn calculi (combined with mild hydronephrosis in 1 patient, moderate hydronephrosis in 1 patient). Four patients were diagnosed with ureteral calculus (combined with mild hydronephrosis in 2 patients, moderate hydronephrosis in 1 patient, severe hydronephrosis in 1 patient). In all 6 patients, the tract was dilated with fascial dilators. Immediately after dilator removal, brisk venous bleeding was noted. A nephrostomy tube was inserted promptly through the sheath to tamponade the tract and was immediately closed. Five cases were diagnosed by CT after operation, and 1 case was early diagnosed by intraoperative injection of contrast medium through nephrostomy tube. The nephrostomy tube was misplaced in 5 patients with left upper urinary tract calculi, and in 1 patient with right upper urinary tract calculi. The tip of nephrostomy tube was located in ipsilateral renal vein in 3 patients with left upper urinary tract calculus, inferior vena cava in 2 patients with left upper urinary tract calculus, and contralateral renal vein in 1 patient with right upper urinary tract calculus. No venous thrombosis of renal vein or inferior vena cava was founded in the 6 patients. All 6 patients were managed with strict bed rest, intravenous antibiotics, and one-step or two-step tube withdrawal under close monitoring. One step method referred to total removal of nephrostomy tube under ultrasonic monitoring. Two step method referred to retracting the end of nephrostomy tube into the renal sinus under CT monitoring in the first step, then the nephrostomy tube was completely removed under ultrasound monitoring.Results:All 6 patients were successfully managed with strict bed rest, intravenous antibiotics, and one-step or two-step tube withdrawal under close monitoring. The tube was withdrew by one-step method in 1 patient, by two-step method in 5 patients. The original operations were performed successfully under close observation in 4 patients during the same hospitalization and in 1 patient during the next hospitalization. Other type of operation in 1 patient was performed during the next hospitalization. The all 6 patients were discharged uneventfully. The stone was cleared.Conclusions:Intravenous misplacement of a nephrostomy tube is mainly diagnosed by CT. The nephrostomy tube should be sealed immediately after diagnosis. The intravenously misplaced nephrostomy tube can be successfully removed by one-step or two-step withdrawing under close monitoring. Upper urinary tract stones can be successfully treated at the same time or by stages.
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ABSTRACT Purpose: We aimed to perform a systematic review to assess perioperative outcomes, complications, and survival in studies comparing ureteral stent and percutaneous nephrostomy in malignant ureteral obstruction. Materials and Methods: This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Meta-analyses were performed on procedural data; outcomes; complications (device-related, accidental dislodgement, febrile episodes, unplanned device replacement), dislodgment, and overall survival. Continuous variables were pooled using the inverse variance of the mean difference (MD) with a fixed effect, and 95% confidence interval (CI). The incidences of complications were pooled using the Cochran-Mantel-Haenszel method with the random effect model and reported as Odds Ratio (OR), and 95% CI. Statistical significance was set two-tail p-value <0.05 Results: Ten studies were included. Procedure time (MD −10.26 minutes 95%CI −12.40-8.02, p<0.00001), hospital stay (MD −1.30 days 95%CI −1.69 − −0.92, p<0.0001), number of accidental tube dislodgments (OR 0.25 95% CI 0.13 - 0.48, p<0.0001) were significantly lower in the stent group. No difference was found in mean fluoroscopy time, decrease in creatinine level post procedure, overall number of complications, interval time between the change of tubes, number of febrile episodes after diversion, unplanned device substitution, and overall survival. Conclusion: Our meta-analysis favors stents as the preferred choice as these are easier to maintain and ureteral stent placement should be recommended whenever feasible. If the malignant obstruction precludes a stent placement, then PCN is a safe alternative.
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This study reported three patients with inferior vena cava (IVC) injury during percutaneous nephrostomy or nephrostomy catheters exchange. After CT examination, the tube of one case with IVC injury during percutaneous nephrostomy was directly extracted under the supervision of CT. The tube of the other 2 cases with IVC injury during nephrostomy catheters exchange were gradually removed after CT examination. The three patients’ nephrostomy tubes were removed successfully after surgery, without secondary vena cava, renal vein injury, and secondary thrombosis, and then they were all safely reperformed with percutaneous nephrostomy.
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Objective:To explore the clinical value of modified upper urinary tract video urodynamics in evaluating the surgical effect and guiding the follow-up treatment after ureteral reconstruction.Methods:From December 2018 to November 2020, sixty-nine patients underwent upper urinary tract reconstruction and received modified video urodynamics at the time of nephrostomy removal 3 months after the surgery in the RECUTTER database (29 cases in Peking University First Hospital, 22 cases in Emergency General Hospital, and 18 cases in Beijing Jiangong Hospital). There were 39 males and 30 females, with an average age of (40.4±12.7)years. The stricture was located in left in 34 patients, right side in 27 patients, and bilateral sides in 8 patients. The upper, middle, and lower thirds of the ureter were affected in 26, 10, and 33 cases, respectively. The preoperative creatinine was (92.3±26.9)μmol/L, and the estimated glomerular filtration rate (eGFR) was (85.1±23.2)ml/(min·1.73m 2). The upper urinary tract reconstruction included ileal replacement of ureter in 25 cases (36.2%), pyeloplasty in 8 cases (11.6%), ureteroneocystostomy in 9 cases (13.0%), boari flap in 6 cases (8.7%), lingual mucosal graft ureteroplasty in 9 cases (13.0%), appendiceal onlay ureteroplasty in 3 cases (4.3%), ureteroureterostomy in 3 cases (4.3%), and balloon dilation in 6 cases (8.7%). Based on the pressure and imaging, the results could be divided into three types, type Ⅰ, the pressure difference remained stable near baseline, and the renal pelvis pressure was below 22 cmH 2O(1 cmH 2O=0.098 kPa), and the reconstructed ureter is well visualized during the whole perfusion process; type Ⅱ, the pressure difference increases with the perfusion, but it can decrease to a normal level with the ureteral peristalsis; type Ⅲ, the pressure difference exceeds 15 cmH 2O, and the ureteral peristalsis is weak or disappears at the same time. The management strategies and treatment effects of different subtypes were analyzed. Successful treatment was defined as no further treatment required, the absence of hydronephrosis-related symptoms, and the improved or stabilized degree of hydronephrosis. Results:All 69 patients successfully completed upper urinary tract video urodynamics. The pressure difference was higher than 15 cmH 2O in 8 patients, and the median pressure difference was 37(19-54)cmH 2O. The renal pelvis pressure exceeded 22 cmH 2O in 10 patients, and the median pressure was 63.5 (24-155) cmH 2O. Video urodynamic results of upper urinary tract were classified as type Ⅰ in 60 cases, type Ⅱ in 5 cases, and type Ⅲ in 4 cases. Patients in type Ⅰ do not require other treatment after nephrostomy tube removal. Patients in type Ⅱ should avoid holding urine after the removal of nephrostomy and D-J tubes. All patients in type Ⅲ received further treatment, of which 2 patients replaced D-J tube regularly, 1 patient underwent long-term metal ureteral stent replacement, and 1 patient underwent ureteroscopic balloon dilation. The median follow-up time was 24 (18-42) months. All patients in type Ⅰ met the criteria for surgical success, The pre-and postoperative creatinine in type Ⅰ patients were (88.71±23.09)μmol/L and (88.75±23.64)μmol/L ( P=0.984), and eGFR were (88.06±22.66)ml/(min· 1.73m 2)and (87.97±23.01)ml/(min·1.73m 2), respectively( P=0.969). For type Ⅱ patients, ultrasound showed that the degree of hydronephrosis improved in 3 cases and remained stable in 2 cases. The pre-and postoperative creatinine were (105.97±7.75)μmol/L and (97.63±7.56)μmol/L ( P=0.216), and eGFR were (69.08±14.74)ml/(min·1.73m 2)and (75.95±14.02)ml/(min·1.73m 2)( P=0.243), respectively. For type Ⅲ patients, ultrasound showed that the degree of hydronephrosis remained stable. The pre-and postoperative creatinine were (105.14±44.34)μmol/L and (101.49±57.02)μmol/L ( P=0.684), and eGFR were (65.32±19.85)ml/(min·1.73m 2) and (73.42±27.88) ml/(min·1.73m 2), respectively( P=0.316). Conclusions:The pressure and imaging results of modified upper urinary tract video urodynamics can assist in evaluating the surgical effect of ureteral reconstruction, and the classification has certain guiding significance for further treatment.
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Objective:To evaluate the renal injury of ultrasound-guided percutaneous fascia dilatation with one-step and multi-step percutaneous renal dilatation on renal injury in pigs.Methods:20 experimental pigs were randomly divided into 16F group and 24F group, with 10 pigs in each group. Under the guidance of ultrasound, the left and right kidneys of each experimental pig in group 16F were expanded by percutaneous renal multi-step expansion and one-step expansion (multi-step dilation subgroup and one-step dilation subgroup respectively) with 16F expander, and the same operation was performed with 24F expander in 24F group. After the operation, the left and right kidneys were left with fistula tubes for 1 week. The duration of hematuria in the renal fistula tubes was observed and compared. One month later, the experimental pigs were killed and the kidneys were removed. The histopathology of each group was observed under the naked eye and microscope. The scar tissue around the nephrostomy channel was removed, and hematoxylin-eosin (HE) and Masson staining were performed respectively. The scar volume was measured by digital image analysis technology, and the percentage of the scar volume in the renal cortex volume was calculated.Results:There was no significant difference in gross hematuria duration between one-step dilation subgroup [(4.60±1.26)d] versus multi-step dilation subgroup [(4.70±1.17)d] of 16F group ( P>0.05); There was no significant difference in gross hematuria duration between one-step dilation subgroup [(5.40±1.25)d] versus multi-step dilation subgroup [(5.50±1.08)d] of the 24F group ( P>0.05). There was no significant difference in the gross and histological observation of pig kidney specimens in 16F group and 24F group. There was no significant difference in the scar volume of the fistula channel [(0.35±0.04)cm 3, (0.36±0.03)cm 3] and its percentage in the whole renal cortical volume [(0.41±0.05)%, (0.41±0.06)%] between one-step dilation subgroup versus multi-step dilation subgroup of 16F group (all P>0.05); there was no significant difference in the scar volume of the fistula channel [(0.48±0.02)cm 3, (0.49±0.04)cm 3] and its percentage in the whole renal cortical volume [(0.52±0.04)%, (0.53±0.07)%] between one-step dilation subgroup versus multi-step dilation subgroup of 24F group (all P>0.05). The scar volume and its percentage in the whole renal cortical volume of the one-step dilation subgroup and the multi-step dilation subgroup in the 24F group were higher than that of the 16F group, with statistically significant difference (all P<0.05). Conclusions:Both one-step and multi-step percutaneous renal dilatation have less damage to renal parenchyma. The multi-step dilatation has no obvious advantage over one-step dilatation in reducing renal parenchyma injury.
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ABSTRACT Purpose: We aimed to compare the success and complication rates of the anterograde and retrograde Ureterorenoscopy (URS) for impacted upper ureteral stones in patients > 65 years of age. Materials and Methods: Data of 146 patients >65 years of age and underwent anterograde URS (n=68) in supine position or retrograde URS (n=78) for upper ureteral impacted stones>10 mm between January 2014 and September 2018 were collected prospectively. The groups were compared for success and complication rates, duration of operation, hospital stay, and ancillary procedures. Results: Anterograde and retrograde URS groups were similar for demographic and stone related characteristics. The success rate of the anterograde URS group was significantly higher than the retrograde URS group (97.1% vs. 78.2%, p=0.0007). The complication rates were similar for the two groups (p=0.86). Clavien grade I and II complications were observed in 3 patients in each group. The mean hemoglobin drop was 0.5 g/dL in the anterograde URS group and blood transfusion was not performed in any of the patients. The mean duration of operation was 41.2±12.5 minutes in the mini-PNL group and 59.6±15.1 minutes in the RIRS group and the difference was statistically significant (p=0.02). The median duration of hospitalization was 1 day for both groups. Conclusions: Performing anterograde URS in supine position provided better success rates and similar complication rates compared to retrograde URS. Based on these results anterograde URS shall be considered as one of the primary treatment options for management of impacted upper ureteral stones in the elderly population.
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Humans , Aged , Lithotripsy , Ureteral Calculi/surgery , Retrospective Studies , Treatment Outcome , Ureteroscopy , Length of StayABSTRACT
In recent years, with the rapid development of rigid ureteroscopy and flexible ureteroscope lithotripsy in the field of urology, great changes have been made in the treatment of urinary calculi. Although flexible ureteroscope lithotripsy is easy to be damaged and expensive to maintain, it has high technical requirements for doctors, but it does not need to establish other traumatic channels, but uses the natural cavity of human urinary system, It has been paid more and more attention by urologists and has a good development prospect. Stone free rate is an objective index to judge the efficiency of flexible ureteroscope lithotripsy. The stone free rate and treatment after flexible ureteroscope lithotripsy have always been a difficult problem. Many scholars at home and abroad have studied the influencing factors of stone free rate after flexible ureteroscope lithotripsy, studies have shown that large stone load, hard stone composition, narrow angle of renal pelvis and calyceal and severe hydronephrosis are the main risk factors leading to the reduction of postoperative one-time stone free rate. In this paper, the research results in this field at home and abroad will be summarized.
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Percutaneous nephrolithotomy (PCNL) has gradually become a preferred method of treatment modality for kidney stones in adults as well as in paediatric patients. The primary objective of this study was to evaluate the outcomes and complications in patients having multiple and staghorn calculi and of different sizes, who underwent tubeless PCNL at a single, tertiary care hospital.METHODSA retrospective study was conducted at IGIMS, Patna from January 2017 to February 2018. Patients who underwent conventional PCNL with one or two access for single, multiple or staghorn calculus without nephrostomy tube were included in the study. Patients having solitary kidney with stones are excluded from this study. The primary outcomes of the study were haemoglobin, pain score, and duration of hospital stay.RESULTSA total of 96 patients underwent conventional PCNL with a mean age of 34 years and male:female ratio of 1.3:1. Majority of the patients had a single stone (n=54) followed by 28 patients with multiple stones. Medical comorbidities including hypertension, diabetes mellitus and chronic obstructive pulmonary disease were observed in patients of single (n=8), multiple (n=3) and staghorn (n=2) groups, respectively. Postoperative complications such as haematuria and pleural effusion were developed by the patients. Seventy-six patients were treated with single-tract and 20 by double tract PCNL.CONCLUSIONSPCNL is safe and efficient with limited post-operative complications. The number of residual stones were nil in single stone group while in multiple and staghorn groups insignificant number of renal stones was seen.
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OBJECTIVE@#To evaluate the effectiveness of super-selective renal artery embolization in treatment of post-percutaneous nephrolithotomy bleeding, and to analyse the causes of failure embolization.@*METHODS@#In the study, 65 post-percutaneous nephrolithotomy patients with severe renal bleeding and hemodynamic instability were treated by super-selective renal artery embolization. First of all, we performed selective renal arteriography. After clarifying the location of the bleeding, superselective intubation of the injured vessel with a microcatheter was carried out. Then the injured vessel was embolized with Tornado micro-coil. When complete embolization was not achieved with micro-coil, a small amount of gelatin sponge particles were added. If there was no positive finding of the beginning selective renal arteriography, the following measures could be taken to prevent missing lesions: (1) Abdominal aorta angiography was performed to determine whether there were anatomical variations, such as accessory renal arteries or multiple renal arteries; (2) Ultra-selective intubation angiography next to the nephrostomy tube path was performed; (3) Renal arteriography was repeated; (4) Renal arteriography after removing the nephrostomy tube while retaining the puncture channel. We evaluated the different angiographic findings and analysed the causes of embolization failure.@*RESULTS@#Bleeding was successfully controled in 60 patients (62 kidneys) whose renal arteriography was postive. Positive findings included: pseudoaneurysm formation, patchy contrast extravasation, pseudoaneurysm combined with arteriovenous fistula, contrast agent entering the collection system, extravascular perinephric leakage of contrast. After first embolization, bleeding was controled in 53 patients (55 kidneys). The success rate after the first and second embolization was 88.7% and 96.7% respectively. The second session was required because of failure to demonstrate bleeding arteries during the first session (4 patients, 57.1%) and recurrent hemorrhage of the embolized injured arteries (2 patients, 28.6%). In 5 patients with no positive findings, after conservative treatment, hematuria disappeared. All the patients were followed up for 3, 6, and 12 months after embolization, and no hematuria occurred again, and no sustained and serious renal insufficiency.@*CONCLUSION@#Super-selective renal artery embolization is an effective treatment for post percutaneous nephrolithotomy bleeding. The main cause of failure is omitting of injured arteries during renal arteriography. Renal artery branch injury has various manifestations. Attention should paid to the anatomical variation of the renal artery, and patient and meticulous superselective intubation angiography is the key to avoiding missing the lesion and improving the success rate of embolization.
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Humans , Embolization, Therapeutic , Hemorrhage/etiology , Nephrolithotomy, Percutaneous/adverse effects , Nephrostomy, Percutaneous , Renal Artery , Retrospective StudiesABSTRACT
Objective@#To explore the application value of B-mode ultrasound combined with real-time color doppler ultrasound in percutaneous nephrolithotomy and provide guidance for clinical application.@*Methods@#A total of 150 patients underwent percutaneous nephrolithotomy from December 2015 to December 2017 in the People's Hospital of Lishui were selected.According to different ultrasound guidance methods, the patients were divided into two groups.The single group(70 cases) received B-guided puncture.In the combined group(80 cases), B-ultrasound combined with real-time color doppler ultrasound-guided puncture was applied.The incidence of complications and the success rate of lithotomy were compared between the two groups.The changes in renal artery blood flow parameters[end diastolic velocity(EDV), peak systolic velocity(PSV) and resistance index(RI)] before and after surgery in the combined group were observed.@*Results@#The incidence of complications in the combined group was 2.50%(2/80), which was lower than that in the single group[14.29%(10/70)](χ2=7.046, P<0.05). The success rate of stone extraction in the combined group was 98.75%(79/80), which was higher than that in the single group[85.71%(60/70)](χ2=9.336, P<0.01). The EDV and PSV of the renal interlobar arteries of the combined group before and after surgery had statistically significant differences (t=3.794, 5.385, all P<0.05), but the RI had no statistically significant difference (P>0.05). The EDV and PSV of renal segment arteries in the combined group before and after surgery had statistically significant differences (t=4.535, 4.884, all P<0.05), while the RI had no statistically significant difference (P>0.05). The EDV and PSV of renal aorta of the combined group before and after surgery showed no statistically significant differences (all P>0.05), while the RI showed statistically significant difference (t=4.360, P<0.05).@*Conclusion@#B-mode ultrasound combined with real-time color doppler ultrasound guidance for percutaneous nephrolithotomy can help reduce the incidence of complications and improve the success rate of stone extraction to a certain extent.
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This report is about the application of interventional therapy for bladder rectal residual fistula in a patient whose postoperative rectal stump tumor invaded the bladder and underwent radiotherapy and chemotherapy, resulting in urinary fistula, which seriously affected the quality of life. Referring to the treatment experience of visicovaginal fistula, the patient successfully adopted double percutaneous nephrostomy combined with ureter occlusion stent and achieved good palliative treatment effect.
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This report is about the application of interventional therapy for bladder rectal residual fistula in a patient whose postoperative rectal stump tumor invaded the bladder and underwent radiotherapy and chemotherapy,resulting in urinary fistula,which seriously affected the quality of life.Referring to the treatment experience of visicovaginal fistula,the patient successfully adopted double percutaneous nephrostomy combined with ureter occlusion stent and achieved good palliative treatment effect.
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Objective To analyze the effectiveness and the best drainage time of transurethral ureteral stent (D-J catheter) placement or percutaneous nephrostomy (PCN) in treating upper urinary tract calculi with infection at different time points after admission. Methods A total of 104 patients with upper urinary tract calculi and infection were enrolled in our hospital from Jan. 2018 to Dec. 2019. They were randomly divided into D-J catheter group and PCN group. According to the time from admission to operation, each group was then further divided into subgroups of ≤2 h, ＞2 h to 12 h and ＞12 h to 24 h (24, 18 and 10 cases, respectively). The body temperature, blood white blood cell (WBC) count and neutrophil proportion, C-reactive protein (CRP), serum procalcitonin, urine WBC count and the time of body temperature returning to normal were analyzed preoperatively and 1-3 d postoperatively. Results The patients in the two groups successfully received the operation with no change in operation mode. On the first day after the operation, the urine WBC counts were increased significantly in the three subgroups of each group (all P＜0.05). The body temperature, blood WBC count and neutrophil proportion, CRP and serum procalcitonin were significantly higher in the three subgroups of the D-J catheter group than those in the three subgroups of the PCN group, while the urine WBC count was significantly lower (all P＜0.05). In the two groups, the body temperature, blood WBC count and neutrophil proportion, CRP, serum procalcitonin and WBC count were significantly higher in the ＞12 h to 24 h subgroup than those in the ≤2 h and ＞2 h to 12 h subgroups (all P＜0.05). On the second day after the operation, the body temperature, blood WBC count and neutrophil proportion, CRP, serum procalcitonin and urine WBC count were significantly lower in each subgroup of the PCN group than those in each subgroup of the D-J catheter group (all P＜0.05). On the third day after the operation, the body temperature, blood WBC count and neutrophil proportion, CRP and serum procalcitonin were basically decreased to normals, but the above indexes were significantly higher in the ＞12 h to 24 h subgroup than those in the ≤2 h and ＞2 h to 12 h subgroups (all P＜0.05). The time of body temperature returning to normal was similar between the ≤2 h and ＞2 h to 12 h subgroups of the two groups (all P＞0.05), while the time in the ＞12 h to 24 h subgroup of the D-J catheter group was significantly longer than that of the PCN group (P＜0.05). Conclusion Transurethral D-J catheter placement and PCN drainage within 12 h after admission can achieve good efficacy in treating patients with upper urinary tract calculi and infection, and the infection control of PCN is better.
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Background: Nephrostomy performed as an emergency procedure to drain the obstructed calyceal system is a lifesaving procedure. Posterolateral approach is usually done to access the avascular plane of Brodel to avoid hemorrhage. This study evaluates the feasibility and complications in percutaneous nephrostomies placed at mid and anterior axillary line entry sites as it was found to be easier approach.Methods: A prospective study with 126 percutaneous nephrostomies performed with Ultrasound guidance, using single puncture technique and 8.5F pigtail catheter. The complications rates were analyzed according to WHO guidelines. Results: The technical success rate was 98.4%. Three hemorrhagic complications (2.38%) were recorded without any major interventions. Increased incidence (11.9%) of transient hematuria was observed with five cases (3.9%) of infection at entry site. One case (0.79%) of peritoneal breech recorded with no significant intraperitoneal collection. Conclusions: Placement of Percutaneous Nephrostomy tube at mid or the anterior axillary line appears to be a feasible and easy approach, as its complications rates are within acceptable limits with an advantage of increased patient comfort.
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Abstract Objective: To compare two percutaneous techniques used in the treatment of malignant obstructive uropathy-antegrade double-J stent placement (JJ stenting) and percutaneous nephrostomy-in terms of their cost-effectiveness, from the perspective of the Brazilian public health care system. Materials and Methods: In this cost-effectiveness analysis, we employed decision-analytic modeling. We calculated material costs from 2017 factory prices listed by the Brazilian Pharmaceutical Market Regulatory Board (for medications) and published in the journal Revista Simpro (for medical devices). Procedure-related costs were evaluated, as were the rates of technical and clinical success. Those measures were then used as inputs for a cost-effectiveness analysis comparing the two procedures. Results: The sample comprised 41 patients, of whom 16 underwent antegrade JJ stenting (26 procedures) and 10 underwent percutaneous nephrostomy (15 procedures). Patient records, radiology reports, and expense reports of the interventional radiology department of the public hospital where the study was conducted were analyzed retrospectively. There were no significant complications: one patient had low back pain, and one had a transient retroperitoneal hematoma. The mean procedure time was 24 min, and clinical success (improvement in serum creatinine and resolution of hydronephrosis) was achieved in 97.5% of the cases. The average cost of JJ stenting was significantly lower than was that of percutaneous nephrostomy (US$164.10 vs. US$552.20). Conclusion: In the absence of any clinical contraindications, antegrade JJ stenting is a suitable alternative to both percutaneous nephrostomy and retrograde stenting in patients with dilated renal collecting systems secondary to malignant ureteral obstruction, providing significant cost savings and high success rates.
Resumo Objetivo: Comparar a relação custo-efetividade de duas técnicas percutâneas utilizadas no tratamento da uropatia obstrutiva maligna - inserção anterógrada de cateter duplo J (JJ) versus nefrostomia percutânea - sob a perspectiva do sistema de saúde pública brasileira. Materiais e Métodos: Nesta análise de custo-efetividade por modelo analítico de decisão, os custos de material foram calculados a partir dos preços de fábrica de 2017 listados pela Câmara Brasileira de Regulamentação de Medicamentos (para medicamentos) e publicados na Revista Simpro (para dispositivos médicos). Custos relacionados ao procedimento e taxas de sucesso técnico e clínico foram avaliados. Essas medidas foram então usadas como insumos para uma análise de custo-efetividade comparando os dois procedimentos. Resultados: A amostra foi composta de 41 pacientes, dos quais 16 foram submetidos a 26 procedimentos de inserção anterógrada de JJ e 10 foram submetidos a 15 nefrostomias percutâneas. Registros de pacientes, relatórios de radiologia e relatórios de despesas do serviço de radiologia intervencionista do hospital onde o estudo foi conduzido foram analisados retrospectivamente. Não houve complicações significativas: um paciente apresentou lombalgia e um apresentou hematoma retroperitonial transitório. O tempo médio de procedimento foi 24 minutos e o sucesso clínico (melhora da creatinina sérica e resolução da hidronefrose) foi alcançado em 97,5% dos casos. O custo médio da inserção de JJ (US$ 164.10) foi significativamente menor do que o da nefrostomia percutânea (US$ 552.20). Conclusão: Na ausência de qualquer contraindicação clínica, a inserção anterógrada de JJ é uma alternativa adequada à nefrostomia percutânea e inserção retrógrada em pacientes com sistema coletor renal dilatado secundário a obstrução maligna, proporcionando economia significativa e altas taxas de sucesso.
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Abstract Objective: To establish an overview of computed tomography (CT)-guided percutaneous nephrostomy performed at a referral center for cancer, addressing the characteristics of patients submitted to this intervention, as well as the indications for it, the technical specificities of it, and its main complications. Materials and Methods: This was a retrospective study involving a review of the electronic medical records and images of patients submitted to CT-guided percutaneous nephrostomy at a referral center for cancer between 2014 and 2016. Results: A total of 201 procedures were evaluated. In most cases, the obstruction was caused by a malignant neoplasm. Complications occurred in 9.5% of the cases, and an additional intervention was required (typically for catheter repositioning) in 36.6%. Post-procedure complications were not found to be significantly associated with the type of previous cancer treatment, the technique used, the caliber of the drain used in the procedure, or the degree of dilatation of the collection system prior to the procedure. Conclusion: In cancer patients, CT-guided percutaneous nephrostomy is an effective treatment, with success rates and complication rates similar to those reported in the general population.
Resumo Objetivo: Estabelecer o perfil da nefrostomia percutânea guiada por tomografia computadorizada (TC) em um centro de referência oncológico, conhecendo as características do paciente submetido a esta intervenção, indicações e especificidades técnicas do procedimento, além das complicações mais frequentes. Materiais e Métodos: Foi realizada revisão dos prontuários eletrônicos e das imagens de pacientes submetidos a nefrostomia percutânea guiada por TC entre os anos de 2014 e 2016 em um centro de referência oncológico. Resultados: Foram avaliados 201 procedimentos. As doenças neoplásicas malignas foram as principais causas da obstrução. Houve necessidade de reabordagem em 36,6% dos casos, em sua maioria para reposicionamento do cateter, e ocorreram complicações em 9,5% dos casos. Não houve associação estatisticamente significante entre as complicações pós-nefrostomia percutânea e o tipo de tratamento oncológico prévio, a técnica empregada, o calibre do dreno utilizado no procedimento, ou o grau de dilatação do sistema coletor prévio ao procedimento. Conclusão: A nefrostomia percutânea guiada por TC é eficaz em pacientes oncológicos, com taxas de sucesso e complicações semelhantes às observadas na população geral na literatura.
ABSTRACT
Colonic perforation is an unusual and serious complication of percutaneous nephrolithotomy. It can result in more complicatedopen exploration of the abdomen, involving colostomy construction. The necessity of a second operation for the closure of thecolostomy causes financial and emotional burden on the patients and surgeons.
ABSTRACT
Objective: to evaluate the impact on the quality of life as well as anxiety and pain in patients with nephrostomy tubes. Method: this is a longitudinal descriptive study performed on a sample of n=150 patients. To evaluate the quality of life, the EuroQol-5D questionnaire was used; anxiety was quantified by the Beck Anxiety Inventory; to study pain, a visual analogue scale was employed. Results: statistically significant differences were found in the quality of life, with its worsening (r = 0.51; p <0.01) when evaluated at the first tube replacement. Patients presented mild to moderate anxiety before the procedure, which was reduced at the first tube replacement, although this difference was not significant (r = 0.028, p = 0.393). Finally, the degree of pain was also significantly reduced (r = 0.13, p<0.01) after six weeks. As for gender, women presented the worst values in the three variables studied (worse quality of life and greater anxiety and pain). Conclusions: nephrostomy tubes have a negative impact on the patient's quality of life. During the time they live with these tubes, patients have mild to moderate pain and anxiety.
Objetivo: avaliar o impacto na qualidade de vida, bem como a ansiedade e dor em pacientes com sondas de nefrostomia. Método: estudo descritivo longitudinal realizado em uma amostra de n=150 pacientes. Para avaliar a qualidade de vida, utilizou-se o questionário EuroQol-5D; a ansiedade foi quantificada pelo Inventário de Ansiedade de Beck; para estudar a dor, foi utilizada uma escala visual analógica. Resultados: foram encontradas diferenças estatisticamente significativas na qualidade de vida, com sua piora (r = 0,51; p <0,01) quando avaliada na primeira troca da sonda. Os pacientes apresentaram ansiedade leve a moderada antes do procedimento, que foi reduzida na primeira troca da sonda, embora esta diferença não tenha sido significativa (r = 0,028; p = 0,393). Finalmente, o grau de dor também foi significativamente reduzido (r = 0,13; p<0,01) após seis semanas. Quanto ao sexo, as mulheres apresentaram os piores valores nas três variáveis estudadas (pior qualidade de vida e maior ansiedade e dor). Conclusões: Sondas de nefrostomia têm um impacto negativo na qualidade de vida do paciente. Durante o tempo que convivem com estas sondas, os pacientes têm dor e ansiedade leve a moderada.
Objetivo: valorar el impacto en la calidad de vida, así como la ansiedad y el dolor que presentan los pacientes portadores de sondas de nefrostomía. Método: estudio descriptivo longitudinal que se llevó a cabo sobre una muestra de n=150 pacientes. Para valorar la calidad de vida se empleó el cuestionario EuroQol-5D; la ansiedad fue cuantificada mediante el Inventario de Ansiedad de Beck; para estudiar el dolor se empleó una escala visual analógica. Resultados: encontramos diferencias estadísticamente significativas en la calidad de vida, produciéndose su empeoramiento (r=0.51; p<0.01) cuando fue valorada en el primer cambio de sonda. Los pacientes presentaron una ansiedad leve a moderada previa al procedimiento, que se vio reducida en el primer cambio de sonda, si bien esta diferencia no resultó significativa (r=0.028; p=0.393). Por último, el grado de dolor también se vio disminuido de forma significativa (r=0.13; p<0.01) al cabo de seis semanas. Por sexos, las mujeres presentaron peores valores en las tres variables estudiadas (peor calidad de vida, y mayor ansiedad y dolor). Conclusiones: las sondas de nefrostomía suponen un impacto negativo en la calidad de vida del paciente. Durante el tiempo que conviven con dichas sondas, los pacientes presentan dolor y ansiedad leve a moderada.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Anxiety Disorders , Pain , Psychiatric Status Rating Scales , Quality of Life , Nephrostomy, Percutaneous , Surveys and Questionnaires , Needs AssessmentABSTRACT
Objective@#To compare the safety and efficiency of totally ultrasonography-guided super-mini-percutaneous nephrolithotomy(SMP) in the treatment of upper urinary stone in adults and children(<14years).@*Methods@#From May 2015 to July 2018, 81 cases of children(53%) and 71(47%) cases of adults with upper tract stones underwent the SMP by total ultrasound guidance. In the group of children, it’s including 53 male and 28 female with 85 channels in total, the patients age ranged from 10 months to 14 years, [mean (56.0±39.7) months], The stone size ranged from 0.8-3.5 cm, [mean (1.7±0.7)cm]. About stone distribution, 42 cases of pelvic stones, 25 cases of calyceal and pelvic stones, 5 cases of calyceal stones, 7 cases of upper uretaral stones, 1 case of upper ureteral and calyceal stones, 1 case of malformation with double renal pelvis and ureter. Urinary infection rate was 86.4%(70/81), positive rate of urinary culture was 39.5%(32/81). In the group of adults, it’s including 43 male and 28 female, the patients aged from 18 to 81 years, [mean (44.1±15.4)years], The stone size ranged from 1.0-3.0 cm, [mean (1.7±0.6)cm]. About Stone distribution, 19 cases of pelvic stones, 13 cases of calyceal and pelvic stones, 7 cases of calyceal stones, 24 cases of upper uretaral stones, 3 cases of upper ureteral and calyceal stones, 1 case of malformation with double renal pelvis and ureter. Urinary infection rate was 87.3%(62/71), positive rate of urinary culture was 26.8%(19/71). The patient was placed in the lithotomy position under general anesthesia. A 5F ureteric catheter was retrogradely inserted into the collecting system and urethral catheter was placed in the bladder. The patient was then turned prone. The selected calix was punctured under ultrasound guidance by 18G puncture needle and a 0.032 inch guidewire was inserted into the collecting system. Nephrostomy tract was established using Dilators(it was done in one step for 12F and in two steps for 14F). After the corresponding size of suction-evacuation sheath was placed, the sheath was connected to the specimen collection bottle via the oblique branch of a metal connector. The miniature endoscope was inserted into the sheath to observe the collecting system and stone fragmentation was completed by using YAG laser or pneumatic lithotripter. Stone free rate after surgery at 1day(SFR) and 1 month(1 month SFR), stone size, operative time(from starting fragmentation to the end of the surgery), hemoglobin drop and hematocrit drop in the first day after surgery, rate of surgecal complications, tubeless rate(totally tubless: no ureteric stent and nephrostomy tube; tubeless: no nephrostomy tube but ureteric stent), average length of hospital stay and urinary infection were recorded and compared.@*Results@#In children group, mean operative time was (27.7±13.0)min(range 5-60 min), SFR and SFR at 1 month were 96.3%(78/81)and 98.8%(80/81), mean hemoglobin drop was (8.0±9.1)g/L(range 0-41 g/L), mean hematocrit drop was 0.026±0.029(range 0-0.135), totally tubeless rate was 86.4%(71/81), mean hospital stay was (2.5±0.9)days(range 1-5 days). Complications were observed in 9 cases and classified using Calvien grading system, Grade Ⅰ in 8 cases: postoperative fever in 4, hematuresis in 1, perirenal hematoma, postoperative distal ureteral stone in 1 cases and delayed recovery of intestinal function in 1 case, all had a spontaneous recovery without special managements; Grade Ⅲb in 1 case, massive ascites was discovered during the surgery, and rcovered by puncture drainage.In adult group, mean operative time was (31.2±15.3)min(range 7-80 min), SFR and SFR at 1 month were 97.2%(69/71) and 98.6%(70/71), mean hemoglobin drop was (11.9±8.7)g/L(range 0-32 g/L), mean hematocrit drop was 0.030±0.027(range 0-0.106), totally tubeless rate was 87.3%(62/71), mean hospital stay was(2.4±1.1)days(range 1-8 days), urinary infection rate was 87.3%(62/71), positive rate of urinary culture was 26.8%(19/71). Complications were observed in 4 cases, Grade Ⅰ in 3 cases: hematuresis in 2 and delayed recovery of intestinal function in 1 case, all had a spontaneous recovery without special managements; Grade Ⅲb in 1 case, postoperative distal ureteral stone in 1 cases and cured by ureteroscopic lithotripsy. According to data about Hb drop, risk of hemorrhage is lower in children than adult significantly(P<0.05). There is not significant difference in stone free rate, stone size, operative time, hematocrit drop, surgery complications, totally tubeless rate, stone complexity, average length of hospital stay and urinary infection(P>0.05).@*Conclusions@#With the characteristics of safe, efficacious and rapid recovery, super-mini-percutaneous nephrolithotomy(SMP) can be used as the first choice of the treatment for upper urinary stone both in adults and children.