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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 safety and effectiveness of percutaneous nephrostomy in the treatment of obstructive urinogenic sepsis complicated with thrombocytopenia.Methods Clinical data of 116 patients with urogenic sepsis complicated with thrombocytopenia admitted to Xiaogan Hospital of Wuhan University of Science and Technology from October 2017 to May 2021 were collected.There were 23 patients with abnormal renal function indexes(serum creatinine＞500 mmol/L).Preoperative urinary tract CT or ultrasound were performed to confirm hydronephrosis.According to the number of platelets in preoperative blood routine,they were divided into study group(platelet＜50 × 109/L)and control group(platelet ≥ 50 × 109/L).Percutaneous nephrostomy was performed under ultrasound guidance in both groups.The outcome indexes included the success rate of operation,body temperature,routine white blood cell count,the time to return to normal of procalcitonin,postoperative bleeding,shock,and side injury.Results In the study group,preoperative fever time was(6.9±2.2)days,platelet count was(35± 10.2)x 109/L,preoperative procalcitonin(PCT)was(36±6.2)ng/ml,and serum creatinine increased by 30％.While,the data in control group were(4.2+2.0)days,(115±58.9)x 109/L,(20±2.6)ng/ml and 12％,respectively.The difference between the two groups was statistically significant(P＜0.05).The recovery time of PCT in study group and control group was(6.9±2.8)days and(4.8±1.5)days,respectively.The normal recovery time of body temperature was(36.2±3.5)hours and(28.5±2.3)hours,respectively.The recovery time of white blood cell count was(5.3± 1.2)days and(3.2±2.5)days,respectively.The recovery time of platelet was(6.0±2.3)days and(3.5±2.0)days,respectively.The difference between the two groups was statistically significant(P＜0.05).There was no significant difference in surgical success rate,postoperative collateral injury,massive hemorrhage,shock and other complications between the two groups(P＞0.05).Conclusion Percutaneous nephrostomy(PCN)is effective and safe in the treatment of urogenic sepsis with thrombocytopenia,and it is worth popularizing.
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【Objective】 To identify the best surgical treatment for patients with calculous pyonephrosis by evaluating the clinical effectiveness of percutaneous nephrolithotripsy (PCNL) in stageⅠ, percutaneous nephrostomy (PCN) in stageⅠ, and percutaneous nephrolithotripsy in stageⅡ. 【Methods】 For publications published between Jan.2012 and Oct.2022, we thoroughly examined the databases of PubMed, Cochrane Library, Web of Science, EMBASE, CNKI, Wanfang, and VIP.We then chosed the literature based on the inclusion and exclusion criteria.After data were retrieved and literature quality was assessed, Review Manager software (RevMan 5.4.3, Cochrane Collaboration, Oxford, UK) was utilized to Meta-analysis. 【Results】 Out of 688 participants across 105 researches, we chosed 11 trials.Among them, 341 patients received both stageⅠPCN and stage ⅡPCNL (hereinafter referred to as phase ⅡPCNL), while 347 patients received stageⅠPCNL.According to the results of the Meta-analysis, there was no discernible difference between stage Ⅰ PCNL and stage Ⅱ PCNL in terms of stone clearance rate (P=0.95), operation duration (P=0.48), postoperative septic shock (P=0.36), or perirenal effusion infection (P=0.27).There were significant differences between stage Ⅰ PCNL and stage Ⅱ PCNL in fever (P=0.03), indwelling nephrostomy tube time (P=0.01), hospitalization costs (P=0.01), hospitalization time (P=0.01), and postoperative hospitalization time (P=0.02).The following two regimens were comparable in terms of stone clearance rate, operating time, postoperative perirenal effusion infection, and septic shock for patients with calculous pyonephrosis.Despite the fact that there were more patients who developed fever after stage ⅠPCNL, hospitalization costs were lower, indwelling nephrostomy tube time, overall hospitalization time, and postoperative hospitalization time were all reduced. 【Conclusion】 ⅠPCNL was affordable, safe, and successful for treating renal and upper ureteral calculi with pyonephrosis, and it had some promotional value in clinical practice.
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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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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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Objective To explore comprehensive treatment for severe infection caused by ureteral calculus.Methods The clinical data of 12 patients with severe infection caused by ureteral calculus in the Second People's Hospital of Lianyungang from January 2016 to December 2017 were reviewed.The patients cured by anti-infective therapy received one-stage surgical treatment.The patients with ineffective anti-infective therapy received one-stage cystoscopic retrograde double J tube or B ultrasound-guided percutaneous nephrostomy first,then ureteral calculus was treated.Results Two patients were cured by empirical antimicrobial agents.One patient was successfully cured by extracorporeal shock wave lithotripsy (ESWL) and the other by retroperitoneoscopic ureterolithotomy.Ten patients were not responsive to emnpirical antimicrobial agents.Two patients refused treatment and requested discharge from the hospital.The other 8 patients received two-stage treatment.In the stage Ⅰ,cystoscopic retrograde double J tube was accomplished in 3 patients,and 5 patients were treated successfully by percutaneous nephrostomy guided by B ultrasound.In the stage Ⅱ,one patient with ureter stone-street was cured by lithagogue drugs,2 patients were successfully cured by ESWL,one patient by holmium laser lithotripsy under ureteroscope,2 patients by ureterolithotomy and 2 patients by percutaneous nephrolithotomy by endoscopy and holmium laser.Conclusion The therapy of retrograde double J tube at cystoscopy or percutaneous nephrostomy guided by B ultrasound combined with empirical antimicrobial agents in the satae Ⅰ,combined with lithotripsy according to guidelines in the stage Ⅱ in treating severe infection caused by ureteral calculus have more advantage such as simple,less injury,rapid control of infection,less complication and satisfactory effect.It is an ideal method.
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Objective@#To explore comprehensive treatment for severe infection caused by ureteral calculus.@*Methods@#The clinical data of 12 patients with severe infection caused by ureteral calculus in the Second People's Hospital of Lianyungang from January 2016 to December 2017 were reviewed.The patients cured by anti-infective therapy received one-stage surgical treatment.The patients with ineffective anti-infective therapy received one-stage cystoscopic retrograde double J tube or B ultrasound-guided percutaneous nephrostomy first, then ureteral calculus was treated.@*Results@#Two patients were cured by empirical antimicrobial agents.One patient was successfully cured by extracorporeal shock wave lithotripsy (ESWL) and the other by retroperitoneoscopic ureterolithotomy.Ten patients were not responsive to empirical antimicrobial agents.Two patients refused treatment and requested discharge from the hospital.The other 8 patients received two-stage treatment.In the stage I, cystoscopic retrograde double J tube was accomplished in 3 patients, and 5 patients were treated successfully by percutaneous nephrostomy guided by B ultrasound.In the stage II, one patient with ureter stone-street was cured by lithagogue drugs, 2 patients were successfully cured by ESWL, one patient by holmium laser lithotripsy under ureteroscope, 2 patients by ureterolithotomy and 2 patients by percutaneous nephrolithotomy by endoscopy and holmium laser.@*Conclusion@#The therapy of retrograde double J tube at cystoscopy or percutaneous nephrostomy guided by B ultrasound combined with empirical antimicrobial agents in the satae I, combined with lithotripsy according to guidelines in the stage II in treating severe infection caused by ureteral calculus have more advantage such as simple, less injury, rapid control of infection, less complication and satisfactory effect.It is an ideal method.
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Objective To explore the change of urine proteins from nephrostomy tube and renal function in patients with very severe hydronephrosis after nephrostomy in order to determine the treatment strategy of either renal preservation or resection.Methods Retrospective analysis of clinical data from March 2015 to March 2017 of 28 cases with congenital unilateral severe hydronephrosis in children's hospital affiliated to Zhejiang University,including 19 boys and 9 girls,with 20 cases on the left and 8 on the right,an average age of 26.6 (0.3 to 122.0) months at the first consultation and 2 cases of urinary biochemical abnormalities.Front to rear diameter for puncture were between 5.7 and 7.6 cm,with an average of 6.7 cm,and the differential renal function (DRF) for the affected kidneys were 6.98 ％-9.89 ％ (average 8.65 ％) before puncture.The children underwent percutaneous renal perforation fistula.According to the recovery of renal function after perforation fistula,those who underwent nephrectomy were recruited as a nephrectomy group and the children whose kidney were preserved as kidney preservation group.Comparison 24 hours before and 3 months after puncture was made beteween groups regarding the proportion of urine,pH of the renal pelvis urine,oαl microglobulin (α1-MG),albumin (Alb),β2 microglobulin (β2-MG),immunoglobulin G (IgG),transferrin (TRF),and the recovery of the damaged renal function (direnal function DRF).Results Twenty-eight cases of percutaneous nephrolithotomy were successful without puncture complications,with 10 cases in the nephrectomy group and 18 cases in the renal preservation group.The difference of renal pelvis urine from the affected kidney of the nephrectomy group showed no statistical significance 24 hours before and 3 months after the procedure when comparing the following parameters,including urinary specific gravity (1.006 ± 0.007 vs.1.009 ± 0.005),pH value (7.74 ± 0.41 vs.7.70 ± 0.32),urine creatinine value [(462.20 ± 158.01) μmol/L and (449.20 ± 143.41) μmol/L],αl microglobulin [(14.03 ± 4.360) mg/L vs.(13.84 ± 2.55) mg/L],β2 microglobulin [(0.76 ± 0.28) mg/L vs.(0.65 ±0.14) mg/L],immunoglobulin G [(1 292.20 ± 303.50) mg/L vs.(1 175.33 ± 376.67) mg/L],and kidney function (DRF) [(8.86 ±0.67) ％ vs.(9.90 ± 1.26)％].While microalbumin [(8 644.40 ± 829.54) mg/L vs.(3 145.10 ± 1 445.02) mg/L] and transferrin [(445.70 ± 46.71) mg/L vs.(214.30 ± 40.13) mg/L,P ＜ 0.05] were significantly increased 3 months after than 24 h before the procedure in nephrostomy group.There were no significant differences of the urine specific gravity 24h before and 3 months after the procedure in the kidney preserved group (1.003 ± 0.003 vs.1.005 ± 0.003,P ＞ 0.05).The creatinine value of 3 months after the procedure was significantly increased than that 24 hours within the procedure [(654.50 ± 154.52tμmol/L) vs.(423.94 ± 172.74) μmol/L],and the urine pH (7.28 ± 0.32 vs.7.91 ± 0.56),α1 microglobulin [(5.85 ± 0.38) mg/L vs.(12.58 ± 3.40) mg/L],microalbumin [(571.50 ± 167.14) mg/L vs.(2 343.28 ± 576.22) mg/L],β2 microglobulin [(0.14 ±0.05)mg/L vs.(0.53 ±0.13) mg/L],immunoglobulin G [(247.38 ±75.29) mg/L vs.(1 026.44 ±245.42)mg/L],and transferrin [(67.64 ± 16.34) mg/L vs.(249.17 ±78.62) mg/L] were significantly decreased 3 months after than 24 hours before the procedure.The renal function was higher 3 months after than 24 hours within the procedure [(8.53 ± 0.80) ％ vs.(20.50 ± 7.87) ％,P ＜ 0.05].Conclusions The increase of creatinine value and the decrease of urine pH,α1 microglobulin,microalbumin,β 2 microglobulin,immunoglobulin G and transferrin in renal pelvis urine suggested that renal function recovered after renal puncture,which is important for next-step plan of treatment strategy.
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Percutaneous renal puncture device has very important clinical value. Qualified percutaneous renal puncture device is one of the important ways to evaluate its safety and efficacy, and it is also an important prerequisite for the device to be marketed in China. When manufactuers test the product, the selection of representative products is suggested from the aspects of performance parameter, structure, material and production process.
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Humanos , China , Riñón , Nefrostomía Percutánea , PuncionesRESUMEN
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.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Trastornos de Ansiedad , Dolor , Escalas de Valoración Psiquiátrica , Calidad de Vida , Nefrostomía Percutánea , Encuestas y Cuestionarios , Evaluación de NecesidadesRESUMEN
Objective To evaluate the efficacy of double percutaneous nephrostomy combined with ureter occlusion stent in treating cervical cancer complicated with vesicovaginal fistula after radiotherapy. Method A prospective analysis was taken for 12 patients with cervical cancer complicated with vesicovaginal fistula after radiotherapy who were diagnosed by gynecological examination, imaging and cystoscopy. All patients received concurrent double percutaneous nephrostomy and ureter occlusion stent implantation.The improvement of symptoms and postoperative complications were observed.The number of white blood cells in urine,renal function,number of diapers in daily use(pieces),daily vaginal and urethral exudate, pain score,physical status (ECOG) score and quality of life score (KPS) before and 7 d after the procedure were compare by the paired Student's t test. Results Twelve patients were successfully implanted 24 ureter occlusion stents after successful nephrostomy. Postoperatively, urinary fistula immediately disappeared in all patients.One week after operation,bilateral hydronephrosis disappeared in 4 patients, renal insufficiency and renal function returned to normal in 4 patients. There were significant differences in the number of white blood cells in urine,the number of diapers in daily use,the daily vaginal and urethral exudate,pain score,KPS and ECOG score compared with before and 7 d after the procedure(all P<0.05).There was no significant difference in the creatinine and urea nitrogen (all P>0.05). No serious complications occurred after the operation.Conclusion Double percutaneous nephrostomy combined with ureter occlusion stent can effectively and safely treat cervical cancer complicated with vesicovaginal fistula after radiotherapy.
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Objective To investigate the effect of ultrasound guided percutaneous nephrostomy combined with Mailuoning injection on renal function, TGF- β 1 and α -SMA in patients with obstructive hydronephrosis. Methods 37 cases with obstructive hydronephrosis treated in our hospital from June 2014 to December 2016 were enrolled as the research object, all patients after admission were perfect relevant examination, after exclude contraindications underwent ultrasound-guided percutaneous nephrostomy combined with Mailuoning injection treatment. The operative time, the success rate of first puncture, the amount of bleeding during operation, hospitalization time, incidence of complications, preoperative and postoperative 3 d, 7 d renal function preoperative, postoperative, 7 d urine transforming growth factor β 1 (TGF- β 1) and alpha smooth muscle actin (α -SMA) were observed. Results The operation time was 52~93 minutes in 37 patients, the average operation time was (62.31±8.26) minutes; One puncture was successful in 37 cases, the success rate of one puncture was 100%. The intraoperative blood loss was 51 ~ 102 mL, the average amount of bleeding was (80.27±18.15) mL. The hospitalization time was 3 ~ 9 d, the average time was (6.12±1.97)d.In 37 cases, three cases were blocked by ostomy, the incidence rate was 8.11 %; The fistula was removed in one cases, the incidence rate was 2.70%; seven cases with dermatitis around the fistula, the incidence rate was 18.92%. At 3 d after surgery, BUN and Cr were significantly decreased than before operation (P<0.05). At 7 d after surgery, BUN and Cr were significantly decreased compared with preoperative and postoperative 3 d (P<0.05). The levels of TGF-β1 and α-SMA in patients were significantly lower than those before operation at 7 days after operation (P<0.05). Conclusion Ultrasound guided percutaneous nephrostomy combined with Mailuoning injection in the treatment of obstructive hydronephrosis can timely drainage of urine, improve renal function, avoid ipsilateral renal interstitial fibrosis. The utility model has the advantages of high rate of success and safe operation.
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Objective To investigate the effect of ultrasound guided percutaneous nephrostomy combined with Mailuoning injection on renal function, TGF- β 1 and α -SMA in patients with obstructive hydronephrosis. Methods 37 cases with obstructive hydronephrosis treated in our hospital from June 2014 to December 2016 were enrolled as the research object, all patients after admission were perfect relevant examination, after exclude contraindications underwent ultrasound-guided percutaneous nephrostomy combined with Mailuoning injection treatment. The operative time, the success rate of first puncture, the amount of bleeding during operation, hospitalization time, incidence of complications, preoperative and postoperative 3 d, 7 d renal function preoperative, postoperative, 7 d urine transforming growth factor β 1 (TGF- β 1) and alpha smooth muscle actin (α -SMA) were observed. Results The operation time was 52~93 minutes in 37 patients, the average operation time was (62.31±8.26) minutes; One puncture was successful in 37 cases, the success rate of one puncture was 100%. The intraoperative blood loss was 51 ~ 102 mL, the average amount of bleeding was (80.27±18.15) mL. The hospitalization time was 3 ~ 9 d, the average time was (6.12±1.97)d.In 37 cases, three cases were blocked by ostomy, the incidence rate was 8.11 %; The fistula was removed in one cases, the incidence rate was 2.70%; seven cases with dermatitis around the fistula, the incidence rate was 18.92%. At 3 d after surgery, BUN and Cr were significantly decreased than before operation (P<0.05). At 7 d after surgery, BUN and Cr were significantly decreased compared with preoperative and postoperative 3 d (P<0.05). The levels of TGF-β1 and α-SMA in patients were significantly lower than those before operation at 7 days after operation (P<0.05). Conclusion Ultrasound guided percutaneous nephrostomy combined with Mailuoning injection in the treatment of obstructive hydronephrosis can timely drainage of urine, improve renal function, avoid ipsilateral renal interstitial fibrosis. The utility model has the advantages of high rate of success and safe operation.
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SUMMARY Introduction: Obstructive nephropathy is a frequent complication in the course of advanced cervical cancer (CC), and ultrasonography-guided percutaneous nephrostomy (PCN) is a well established technique for fast ureteral desobstruction. Objective: To identify possible factors related to the survival and quality of life of patients with advanced CC presenting acute urinary obstructive complications that after desobstruction by PCN recovered urinary flux and renal function. Method: This is an analytical, descriptive, cross-sectional study that included 45 patients with CC who underwent PCN and were divided into 2 groups: “death” (DG) and “survival” (SG), in a public hospital that is reference for oncologic diseases in Northern Brazil. Results: The mean serum creatinine of the patients preceding PCN was >10 mg/dL, and after PCN <2 mg/dL. The cutoffs of 8.7 g/dL for Hb (p=0.0241) and 27% for Ht (p=0.0065) indicated the values that better discriminate the outcomes of the groups. The presence of low blood pressure was statistically correlated (p=0.0037) to the outcome “death”. Changes in glomerular filtration rate (already reduced in all cases) were not associated to the levels of Hb/Ht or to the outcome “death” during the nephrological follow-up. Conclusion: PCN was responsible for the recovery of renal function in 61.7% of the patients, leading to interruption of renal replacement therapy (RRT) in all of those patients. Hb levels >8.7g/dL and Ht >27% were associated to longer survival, and the presence of low blood pressure during follow-up was associated with progression to death.
RESUMO Introdução: a nefropatia obstrutiva é complicação frequente na evolução do câncer do colo uterino (CCU) avançado e a nefrostomia percutânea guiada por ultrassonografia (NFT) é uma técnica bem estabelecida para a rápida desobstrução ureteral. Objetivo: esclarecer os fatores relacionados à evolução ou não para óbito e qualidade de vida das pacientes com CCU avançado com complicações obstrutivas urinárias agudas e que, após desobstrução pela NFT, recuperaram fluxo urinário e função renal. Método: foi realizado estudo transversal analítico descritivo, que avaliou dois grupos de pacientes com CCU submetidas à NFT [óbito (GO) e sobrevida (GS)], em um hospital público, referência para doenças oncológicas da região Norte do país. Resultados: a creatinina sérica média inicial era >10 mg/dL pré-NFT e tornou-se <2 mg/dL após. Quanto à sobrevida, os pontos de corte de 8,7 g/dL de Hb e 27% de Ht melhor discriminaram a evolução dos grupos GO e GS (p=0,0241 e p=0,0065). Hipotensão se associou significantemente (p=0,0037) com a evolução para óbito. Variações na taxa de filtração glomerular, que já era reduzida em todos os casos, não se associaram aos níveis de Hb/Ht ou à evolução para óbito durante seguimento nefrológico. Conclusão: a NFT permitiu a recuperação da função renal em 61,7% das pacientes com CCU, dispensando terapia de substituição renal. Níveis de Hb >8,7 g/dL e Ht >27% estiveram associados a maior sobrevida, e a hipotensão durante o seguimento associou-se com evolução para óbito.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Anciano , Nefrostomía Percutánea/mortalidad , Neoplasias del Cuello Uterino/complicaciones , Neoplasias del Cuello Uterino/mortalidad , Enfermedades Renales/cirugía , Enfermedades Renales/etiología , Enfermedades Renales/mortalidad , Calidad de Vida , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/etiología , Obstrucción Ureteral/mortalidad , Factores Sexuales , Métodos Epidemiológicos , Factores de Edad , Resultado del Tratamiento , Creatinina/sangre , Tasa de Filtración Glomerular , Persona de Mediana EdadRESUMEN
Objective:To investigate the methods and complications of ultrasound-guided percutaneous nephrostomy (PCN) for treat-ing cancer-related hydronephrosis. Methods:From June 2003 to December 2015, 289 patients (342 kidneys) with cancer-related hy-dronephrosis were treated by ultrasound-guided PCN in Fujian Provincial Hospital. Among the 97 cases of renal insufficiency, 4 pa-tients were treated with hemodialysis before PCN. Except for the anterior mid calyx of nine kidneys in nine patients, the posterior mid or lower pole calyx of all other kidneys was punctured with ultrasound guidance. With the one-step PCN technique, 8F pigtail nephros-tomy tubes were placed into six kidneys in six patients;with the Seldinger PCN technique, 14F balloon and Malecot catheters were placed into 25 kidneys in 25 patients and 311 kidneys in 258 patients, respectively. Results:No severe bleeding and injury in the intes-tine, liver, spleen, pleura, or lung occurred. Two pigtail tubes were blocked one week after PCN. Seven balloon catheters failed to drain well because of the tip and balloon of the catheters located in the proximal part of the dilated ureters. Four balloons slipped out of the collection system of the kidney because of the auto-deflation of three balloons and one case of meager renal parenchyma failing to hold the balloon after a severe hydronephrosis was emptied. All, except 1, Malecot catheter drained well, and 8/9 PCNs through anteri-or mid calyx were successful. Serum creatinine levels were significantly decreased in all the 97 patients with renal insufficiency, of which 81 cases returned to normal, and no one needed persistent hemodialysis. Conclusion:Ultrasound-guided PCN is safe and effec-tive for treating cancer-related hydronephrosis. For appropriately selected patients, puncturing the anterior mid calyx may be an op-tion without additional complications. One-step pigtail nephrostomy tubes are recommended for patients with poor systemic condi-tions. For patients with long life expectancy or suspected complicated urinary infection, large sized Malecot catheters should be consid-ered.
RESUMEN
Objectives: To evaluate an alternative approach to tubeless surgery that allows a second per- cutaneous procedure using the same nephrostomy tract. Methods: Twenty patients underwent percutaneous nephrolithotomy from September 2012 to May 2013 at our institution. Inclusion criteria were: absence of urinary infection, single puncture and operative time less than 2 h. Following the procedure the initially placed ureteral catheter was exteriorized through the working sheath by tying a non-absorbable suture to its end. On postoperative day 1 all patients were studied with non-enhanced CT or X-ray ï¬lm. If the patient was rendered stone free, the stent was removed along with the urethro-vesical catheter. If a residual stone was present, we recovered the ureteral catheter and used the same nephros- tomy tract for a second endoscopic procedure. Patients were assessed for pain, postoperative complications, length of stay, stone free rate, hematocrit and creatinine variations. Results: Thirteen patients met the inclusion criteria. No major complications related to the stent placement and its exteriorization were seen. Two patients required a second percutaneous procedure successfully achieved recovering the ureteral catheter through the nephrostomy tract. Conclusion: We present a safe and simple modiï¬cation of tubeless percutaneous nephrolitho- tomy, with its well-known clinical beneï¬ts but maintaining a safe path for an eventual second look procedure if necessary.(AU)
Objetivos: Evaluar una sencilla modiï¬cación de la nefrolitectomía percutánea tubeless que permita un segundo procedimiento endoscópico utilizando el mismo trayecto percutáneo. Métodos: Veinte pacientes fueron sometidos a nefrolitectomía percutánea en decúbito supino modiï¬cado entre septiembre de 2012 y mayo de 2013 en nuestro centro. Los criterios de inclusión para el estudio fueron: ausencia de infección urinaria, punción única y tiempo opera- torio menor de 2 h. Al ï¬nalizar el procedimiento se instaló una rienda de sutura en el extremo del catéter ureteral, quedando exteriorizada a través del trayecto de nefrostomía para su recuperación en caso de necesidad. Se realizó tomografía computarizada o radiografía simple a todos los pacientes el primer día postoperatorio. Si el paciente estaba «libre de cálculos¼, el catéter ureteral fue retirado junto con la sonda Foley. En caso de litiasis residual se realizó un segundo procedimiento percutáneo, utilizando el mismo trayecto inicial, exteriorizando el catéter ureteral a través del trayecto de la nefrostomía. En todos los pacientes se objetivaron las complicaciones postoperatorias, la estadía hospitalaria y la presencia de litiasis residual, además de la caída del hematocrito y la creatinina. Resultados: Trece pacientes cumplieron los criterios de inclusión. No hubo complicaciones may- ores relacionadas con la colocación del catéter ureteral y su exteriorización. Dos pacientes requirieron una segunda intervención percutánea, lograda con éxito mediante el uso del catéter ureteral reexteriorizado. Conclusión: Se presenta una modiï¬cación segura y sencilla de la nefrolitectomía percutánea tubeless sin renunciar a la posibilidad de recuperar el trayecto de nefrostomía original.(AU)
Asunto(s)
Humanos , Nefrostomía Percutánea , Nefrolitotomía PercutáneaRESUMEN
Since its initial introduction in 1976, percutaneous nephrolithotomy (PCNL) has been widely performed for the management of large renal stones and currently is recommended for staghorn calculi, kidney stones larger than 2 cm, and shock wave lithotripsy-resistant lower pole stones greater than 1 cm. However, except for open and laparoscopic surgery, PCNL is the most invasive of the minimally invasive stone surgery techniques. Over the years, technical and instrumental advances have been made in PCNL to reduce morbidity and improve effectiveness. A thorough review of the recent literature identified five major areas of progress for the advancement of PCNL: patient positioning, method of percutaneous access, development of lithotriptors, miniaturized access tracts, and postoperative nephrostomy tube management. This review provides an overview of recent advancements in PCNL and the outcomes of each area of progress and notes how much we achieve with less invasive PCNL. This information may allow us to consider the future role and future developments of PCNL.