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Resumen Antecedentes: Los catéteres de nefrostomía percutánea (CNP) que se utilizan en algunos hospitales oncológicos condicionan un incremento en las infecciones del tracto urinario (ITU). Objetivo: Determinar el impacto de un programa estandarizado de atención en la incidencia de ITU que requiere hospitalización (ITU-RH). Material y métodos: Estudio retrospectivo que incluyó pacientes con un primer CNP. Se comparó la incidencia, riesgo relativo (RR), costos y evolución de los pacientes con ITU-RH durante el período previo a la intervención (P0) versus posterior a ella (P1). Resultados: Se instalaron 113 CNP durante P0 y 74 durante P1. Durante P0, 61 pacientes (53.9 %) presentaron 64 episodios de ITU-RH, en 22 557 días de uso de CNP. Durante P1, cuatro pacientes (5.4%) cursaron con ITU-RH en el transcurso de 6548 días de uso del CNP (razón de tasa de incidencia de 0.21, IC 95 % = 0.05-0.57). El RR fue de 0.09 (IC 95 % = 0.03-0.25). El costo mensual por día-cama fue de 3823 USD en P0 y de 1076 USD en P1; el de los antibióticos, de 790 USD en P0 y 123.5 USD en P1. Conclusiones: Este estudio resalta la importancia de un programa estandarizado del cuidado de los dispositivos permanentes, el cual disminuye el uso de antibióticos, la hospitalización y el costo de la atención.
Abstract Background: Percutaneous nephrostomy tubes (PNT), which are used in some cancer hospitals, are associated with an increase in the incidence of urinary tract infections (UTI). Objective: To determine the impact of a standardized care program on the incidence of UTI requiring hospitalization (UTI-RH). Material and methods: Retrospective study that included patients with a first PNT inserted. The incidence, relative risk (RR), costs and outcomes of patients with UTI-RH were compared during the period before (P0) vs. after the intervention (P1). Results: 113 PNCs were inserted during P0, and 74 at P1. During P0, 61 patients (53.9%) experienced 64 UTI-RH events in 22,557 PNT days. At P1, four patients (5.4%) had a UTI-RH in 6,548 PNT days (IRR: 0.21, 95% CI: 0.05-0.57). The RR was 0.09 (95% CI: 0.03-0.25). Monthly cost per day/bed was USD 3,823 at P0 and USD 1,076 at P1, and for antibiotics, it was USD 790 at P0 and USD 123.5 at P1. Conclusions: This study highlights the importance of a standardized care program for permanent percutaneous devices, since this reduces antibiotic use, hospitalization, and the cost of care.
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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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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 explore the necessity of opening nephrostomy tube for patients with septic shock follow-ing the indwelling double-J stent of post-percutaneous nephrolithotomy (PCNL),and provide reference for the treatment of septic shock after PCNL.Methods 60 patients with septic shock after PCNL in a hospital from January 1,2015 to December 30,2016 were chosen,patients were randomly divided into clipping nephrostomy tube group (clipping group,n =30) and opening nephrostomy tube group (opening group,n =30),clinical data of two groups of patients were collected and analyzed.Results After 24-hour treatment,heart rate (HR),mean arterial pressure (MAP),oxygen saturation (SpO2),serum lactate (Lac),and hourly urine volume all improved in both groups of patient compared with pre-treatment(all P＜0.05);HR,MAP,SpO2,Lac,and hourly urine volume in opening group after 24-hour treatment were all significantly different from clipping group (all P＜0.05).Levels of serum procalcitonin (PCT) and C-reactive protein (CRP) in two groups after 3-day treatment decreased significantly compared with pre-treatment (both P＜0.05);PCT and CRP levels in opening group after 3-day treatment were both significantly lower than clipping group (both P＜0.05);cure rate of two groups were both 100.00％,hospitalization time and extubation time in opening group were both shorter than clipping group,and cost was less than clipping group,difference were all significant(all P＜0.05).Conclusion Opening nephrostomy tube on the basis of indwelling double-J stent is necessary for patients with septic shock after PCNL.
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Objective:To assess the advantages and nursing experience of foley catheter for nephrostomy tube after minimally invasive percutaneous nephrolithotomy (mPCNL).Methods:From October 2015 to April 2016,the clinical data of 137 patients,who were diagnosed with upper urinary tract calculi and need to perform mPCNL,were collected and randomized into 2 groups:a foley catheter group (research group,n=69) and a normal nephrostomy tube group (control group,n=68).The patients in research group used foley catheter for nephrostomy tube,while those in the control group used normal nephrostomy tube.Bleeding volume,the days of bleeding,pipes shedding and pain degree were compared,and the experience of the nursing process was summarized.Results:The bleeding volume,the days of bleeding in the research group were significantly lower than those in the control group (both P＜0.01).The pipes shedding rate in the research group were lower than that in the control group (P＜0.05).There was no significant difference in postoperative pain scores between the 2 groups (P＞0.05).There was no other complications and discomfortable symptoms in the experimental group.Conclusion:The use of foley catheter for nephrostomy tube after mPCNL is safe,and it can decrease the bleeding volume and pipes shedding rate.It doesn't increase the patient's postoperative pain and can reduce the difficulty and risk for postoperative nursing.