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Chahine R, Mendiratta-Lala M, Consul N, Wang J, Stein EB, Roseland ME, Aslam A. What can go wrong when doing right? A pictorial review of iatrogenic genitourinary complications. Abdom Radiol (NY) 2024:10.1007/s00261-024-04384-8. [PMID: 38832944 DOI: 10.1007/s00261-024-04384-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 06/06/2024]
Abstract
A growing number of treatments for genitourinary diseases can result in various iatrogenic complications. Multimodality imaging in the post-procedural setting is essential for early and accurate diagnosis to limit morbidity and mortality. We review common and uncommon treatment-induced pathologies affecting the genitourinary system via a case-based approach. We illustrate notable complications affecting the kidneys, ureters, bladder, and urethra induced by percutaneous procedures, external beam radiation, immunotherapy, laparoscopic/robotic pelvic surgery, and intravesicular BCG. Finally, we provide guidance on optimal imaging techniques for diagnosis and highlight the role of image-guided interventions for mitigation of complications.
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Affiliation(s)
- Reve Chahine
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA.
| | - Mishal Mendiratta-Lala
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
| | - Nikita Consul
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
| | - Jeffrey Wang
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
| | - Erica B Stein
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
| | - Molly E Roseland
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
| | - Anum Aslam
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
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Zhao X, Yang K, Song B, Qiu H, Zhao J, Liu H, Lin Z, Han L, Zhang R. Amphiphilic nanofibrillated cellulose/polyurethane composites with antibacterial, antifouling and self-healing properties for potential catheter applications. Int J Biol Macromol 2024; 263:130407. [PMID: 38417747 DOI: 10.1016/j.ijbiomac.2024.130407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024]
Abstract
This study focuses on enhancing interventional medical devices, specifically catheters, using a novel composite material. Challenges like corrosion and contamination in vivo, often caused by body fluids' pH, bacteria, and proteins, lead to mechanical damage, bacterial colonization, and biofilm formation on devices like catheters. The objective of this study was to prepare a versatile composite (HFs) by designing polyurethanes (HPU) with an ionic chain extender (HIID) and blending them with amphiphilic nanofibrillated cellulose (Am-CNF). The composite leverages dynamic interactions such as hydrogen bonding and electrostatic forces, as evidenced by Molecular Mechanics (MM) calculations. The H4F0.75 composite exhibited exceptional properties: 99 % length recovery post 600 stretching cycles at 100 % strain, rapid self-healing in artificial urine, high bactericidal activity, and excellent cell viability. Moreover, mechanical aging tests and UV-vis spectral analysis confirmed the material's durability and safety. These findings suggest that the HFs composite holds significant promise for improving catheters' performance in medical applications.
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Affiliation(s)
- Xin Zhao
- School of Materials Science and Chemical Engineering, Ningbo University, Ningbo, Zhejiang 315211, China; Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Zhejiang Engineering Research Center for Biomedical Materials, Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315300, China
| | - Kai Yang
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Zhejiang Engineering Research Center for Biomedical Materials, Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315300, China
| | - Baiyang Song
- Department of Urology, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo 315010, Zhejiang, China.
| | - Haofeng Qiu
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Zhejiang Engineering Research Center for Biomedical Materials, Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315300, China
| | - Jiake Zhao
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Zhejiang Engineering Research Center for Biomedical Materials, Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315300, China
| | - Hongzhi Liu
- School of Materials Science and Engineering, NingboTech University, Ningbo 315100, Zhejiang Province, China
| | - Zhihao Lin
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Zhejiang Engineering Research Center for Biomedical Materials, Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315300, China
| | - Lijing Han
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Zhejiang Engineering Research Center for Biomedical Materials, Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315300, China.
| | - Ruoyu Zhang
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Zhejiang Engineering Research Center for Biomedical Materials, Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315300, China.
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Subramanian P, Sharma A, Soundararajan R, Singhal M. Spectrum of Multidetector Computed Tomography Imaging Findings in Iatrogenic Abdominopelvic Injuries: A Comprehensive Pictorial Review. Indian J Radiol Imaging 2024; 34:139-149. [PMID: 38106862 PMCID: PMC10723973 DOI: 10.1055/s-0043-1775736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Iatrogenic injuries are unavoidable complications of surgeries and minimally invasive procedures. They are generally classified into vascular and nonvascular injuries and based on the time of injury into early and late injuries. Iatrogenic injuries, particularly vascular injuries, increase the mortality and morbidity, with prolongation of hospital-stay. Multidetector computed tomography (MDCT) is a highly sensitive, and often the first imaging modality in suspected iatrogenic injuries. This pictorial review elucidates the imaging considerations and appearances of iatrogenic injuries of the abdominopelvic organs on MDCT.
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Affiliation(s)
- Pavithra Subramanian
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Sharma
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raghuraman Soundararajan
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Wang X, Wu G, Wang T, Liu S, Ding G, Mao Q, Chu Y, Cui Y, Wu J. Meta-analysis of perioperative outcomes and safety of percutaneous nephrostomy versus retrograde ureteral stenting in the treatment of acute obstructive upper urinary tract infection. Ther Adv Urol 2024; 16:17562872241241854. [PMID: 38618182 PMCID: PMC11010740 DOI: 10.1177/17562872241241854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 02/05/2024] [Indexed: 04/16/2024] Open
Abstract
Background The debate regarding the optimal drainage method for acute obstructive upper urinary tract infection persists, focusing on the choice between percutaneous nephrostomy (PCN) and retrograde ureteral stenting (RUS). Aims This study aims to systematically examine the perioperative outcomes and safety associated with PCN and RUS in treating acute obstructive upper urinary tract infections. Methods A comprehensive investigation was conducted using the Medline, Embase, Web of Science, and Cochrane databases up to December 2022, following the guidelines of the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. The utilized keywords included 'PCN', 'RUS', 'acute upper obstructive uropathy', and 'RCT'. Inclusion criteria encompassed studies providing accurate and analyzable data, which incorporated the total subject count, perioperative outcomes, and complication rates. The assessed perioperative outcomes included fluoroscopy time, normalization of temperature, normalization of serum creatinine, normalization of white blood cell (WBC) count, and operative time. Safety outcomes encompassed failure rate, intraoperative and postoperative hematuria, postoperative fever, postoperative pain, and postoperative nephrostomy tube or stent slippage rate. The study protocol was prospectively registered at PROSPERO (CRD42022352474). Results The meta-analysis encompassed 7 trials involving 727 patients, with 412 assigned to the PCN group and 315 to the RUS group. The outcome of the meta-analysis unveiled a reduced occurrence of postoperative hematuria in the PCN group [odds ratio (OR) = 0.54, 95% confidence interval (CI) 0.30-0.99, p = 0.04], along with a decreased frequency of insertion failure (OR = 0.42, 95% CI 0.21-0.81, p = 0.01). In addition, the RUS group exhibited a shorter fluoroscopy time than the PCN group (mean difference = 0.31, 95% CI 0.14-0.48, p = 0.0004). Conclusion Given the significant impact of hematuria and catheterization failure on postoperative quality of life, the preference for PCN appears more advantageous than RUS.
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Affiliation(s)
- Xidong Wang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Gang Wu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Tianqi Wang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Shangjing Liu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Guixin Ding
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Qiancheng Mao
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Yongli Chu
- Department of Scientific Research, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Yuanshan Cui
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, China
| | - Jitao Wu
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, No. 20 East Yuhuangding Road, Yantai, Shandong 264000, China
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Tang X, Wang M, Hu H, Lai CH, Wang Q, Xu K, Xu T, Hu H. Long-term maintenance treatment of recurrent ureteropelvic junction obstruction with covered metallic ureteral stent. Medicine (Baltimore) 2023; 102:e33363. [PMID: 37000084 PMCID: PMC10063295 DOI: 10.1097/md.0000000000033363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 04/01/2023] Open
Abstract
Whether or not the covered metallic ureteral stent can be used as maintenance treatment for recurrent ureteropelvic junction obstruction (UPJO) after pyeloplasty is unknown. Therefore, this study aims to analyze its feasibility. We retrospectively analyzed the records of 20 patients with recurrent UPJO who were treated with the covered metallic ureteral stents from March 2019 to June 2021 at our institution. Then, we assessed their renal function, stent patency and stent-related quality of life by the blood creatinine, renal ultrasound (or computed tomography), and the Chinese version of the ureteral symptom score questionnaire (USSQ). The last follow-up mean blood creatinine dropped from 0.98 ± 0.22 to 0.91 ± 0.21 mg/dL (P = .04), and the median renal pelvic width was reduced from 3.25 (3.10) to 2.00 (1.67) cm (P = .03) compared with the preoperative conditions. Meanwhile, the last follow-up mean USSQ total score of the covered metallic ureteral stent among the 16 patients with preoperative indwelling double-J ureteral stent was 78.56 ± 14.75, significantly lower than the preoperative USSQ total score, which was 102.25 ± 5.57 (P < .001). During the median duration of follow-up of 27.00 (18.00) months, 85% (17/20) of patients maintained unobstructed drainage from the renal pelvis to the ureter. Stent-related complications occurred in 7 patients, 3 of which failed because of complications, including stent migration (1 patient), stent encrustation (1 patient), and stent-related infection (1 patient). The covered metallic ureteral stent is feasible for the long-term maintenance treatment of recurrent UPJO after pyeloplasty.
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Affiliation(s)
- Xinwei Tang
- Department of Urology, Peking University People’s Hospital, Beijing, China
| | - Mingrui Wang
- Department of Urology, Peking University People’s Hospital, Beijing, China
| | - Haopu Hu
- Department of Urology, Peking University People’s Hospital, Beijing, China
| | - Chin-Hui Lai
- Department of Urology, Peking University People’s Hospital, Beijing, China
| | - Qi Wang
- Department of Urology, Peking University People’s Hospital, Beijing, China
| | - Kexin Xu
- Department of Urology, Peking University People’s Hospital, Beijing, China
| | - Tao Xu
- Department of Urology, Peking University People’s Hospital, Beijing, China
| | - Hao Hu
- Department of Urology, Peking University People’s Hospital, Beijing, China
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Ünal E, Çiftçi TT, Akhan O, Akinci D. Imaging-Guided De Novo Retrograde Ureteral Access and Stent Placement without Cystoscopy in Women. J Vasc Interv Radiol 2023; 34:902-909. [PMID: 36736691 DOI: 10.1016/j.jvir.2022.12.483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 12/13/2022] [Accepted: 12/30/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To evaluate the feasibility of a new technique for imaging-guided de novo retrograde ureteral double J (DJ) stent placement without cystoscopy in women. MATERIALS AND METHODS Eighty-four women referred for ureteral stent placement between April 2019 and January 2022 were included. In all the patients, the initial attempt for stent placement was performed in a retrograde fashion. Successful ureteral catheterization and DJ stent placement were considered as technical success. The fluoroscopy time required to catheterize the ureter and that for the entire procedure were recorded. Factors affecting the technical success rate and fluoroscopy time were examined. RESULTS A total of 108 ureteral stent placement procedures in 84 women, with a mean age of 57.5 years (range, 19-85 years), were performed. The most common underlying pathologies were cervical (n = 33, 31%) and ovarian (n = 32, 30%) carcinomas. The most commonly involved segments of the ureter were the lower half (n = 44, 40%) and trigone (n = 39, 36%). The technical success rate was 81.5%, and it reached 93% in the case of lower-half ureteral obstruction. Distorted trigonal anatomy caused by external compression of the bladder wall by a mass was associated with a higher rate of technical failure (90.6% vs 47.8%; P < .001). The use of ultrasound guidance to guide the sheath to the ureteral orifice allowed for a significant decrease in the fluoroscopy time for ureteral catheterization (4.6 minutes ± 3.91 vs 2.26 minutes ± 2.32; P = .003) and that for the entire procedure (9.42 minutes ± 4.95 vs 5.93 minutes ± 4.06; P = .001). CONCLUSIONS Imaging-guided de novo retrograde ureteral catheterization and stent placement can be successfully performed in a high percentage of patients within a reasonable fluoroscopy time without the need for cystoscopy in women.
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Affiliation(s)
- Emre Ünal
- From the Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey.
| | - Türkmen Turan Çiftçi
- From the Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Okan Akhan
- From the Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Devrim Akinci
- From the Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
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Gilberto GM, Falsarella PM, Socolowski LR, Costa AM, Perin ACDS, Garcia RG. Alternative materials for antegrade implantation of a double-J catheter in a public health system. EINSTEIN-SAO PAULO 2023; 21:eCE0437. [PMID: 37132666 PMCID: PMC10124583 DOI: 10.31744/einstein_journal/2023ce0437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/24/2023] [Indexed: 05/04/2023] Open
Affiliation(s)
- Guilherme Moratti Gilberto
- Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Priscila Mina Falsarella
- Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Luis Ricardo Socolowski
- Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Arthur Munhoz Costa
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Arthur Cesar de Souza Perin
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Lee HJ, Kim SY, Cho JY, Kim TM. CT-based preoperative risk assessment of prolonged urine leak in patients undergoing partial nephrectomy. Eur Radiol 2022; 33:3801-3809. [PMID: 36565351 DOI: 10.1007/s00330-022-09361-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/15/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This study aims to evaluate risk factors of prolonged urine leak following partial nephrectomy (PN) to identify objective imaging characteristics on preoperative CT. METHODS A total of 865 patients who underwent PN and had preoperative CT and postoperative imaging were included. We set a twofold size-matched control group without urine leak, with all tumors located ≤ 4 mm to the collecting system to identify imaging parameters that increase the risk of urine leak other than tumor size and location. Four CT parameters that show the relationship of the tumor and collecting system, namely, curvilinear border length, protruding distance, margin at the interface, and pelvicalyceal contact, were analyzed. Multivariate logistic regression analyses were performed to identify significant predictors of urine leak. The diagnostic performance of the significant parameters was evaluated using the area under the receiver operating characteristic curve (AUC). RESULTS Fifty-three of 865 patients (6.1%) demonstrated urine leak. Compared with the control group, urine leak group showed longer curvilinear border length, longer protruding distance, frequent non-smooth contact interface, and frequent direct pelvicalyceal contact (p < 0.05 for all). In the multivariate analysis, pelvicalyceal contact was the independent predictor of urine leak (OR = 2.62; 95% C.I 1.02-6.63). Combining four CT parameters, an AUC of 0.70 with a sensitivity of 58.5% and a specificity of 79.2% for identifying urine leak after PN could be obtained. CONCLUSIONS The four CT features that describe the relationship between the tumor and collecting system might be useful for evaluating the risk of urine leak before PN. KEY POINTS • Four CT parameters (curvilinear border length, protruding distance, margin at the interface, and pelvicalyceal contact) were significantly associated with postoperative urine leak after partial nephrectomy. • A comprehensive preoperative imaging evaluation of the relationship between the tumor and renal sinus may help in selecting the optimal surgical options and afford better patient counseling of complication risk.
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Affiliation(s)
- Hyo Jeong Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Taek Min Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
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Shakiba B, Alemrajabi M, Abian N, Ghaleh A. Incarceration of small bowel following percutaneous nephrostomy tube insertion. Urol Case Rep 2022; 45:102228. [PMID: 36164383 PMCID: PMC9508402 DOI: 10.1016/j.eucr.2022.102228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Behnam Shakiba
- Department of Urology, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Alemrajabi
- Colorectal Surgery, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nasrollah Abian
- Department of Urology, 5 Azar Hospital, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
- Corresponding author. Department of urology, 5 Azar Hospital, 5 Azar Blvd., Gorgan, Golestan province, Iran.
| | - Alireza Ghaleh
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Lory A, Stubbs C, Wolstenhulme S, Khan A. Urinary tract obstruction: Ultrasound-guided intervention. ULTRASOUND (LEEDS, ENGLAND) 2022; 30:264-272. [PMID: 36969536 PMCID: PMC10034656 DOI: 10.1177/1742271x211049495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022]
Abstract
Introduction Urinary tract obstruction (UTO) is a common clinical problem of which there are many potential causes. The aim of this feature article is to explore the role of ultrasound in diagnosing UTO, during guided interventional procedures and the potential procedural complications.Topic description and discussion: Ultrasound is an integral imaging modality throughout the management pathway of a patient with UTO and is often utilised as a first-line test in diagnosis and treatment. Percutaneous nephrostomy is an interventional technique, usually performed by radiologists or interventional sonographers, as either a short- or long-term management strategy. It can either be used in isolation or to gain access to the renal collecting system prior to more complex interventional or surgical techniques. Ultrasound-guided interventional techniques to relieve UTO can be employed in a number of clinical scenarios each with their own indications, contraindications and complications. Conclusion Ultrasound plays a unique role in the planning and active stages of intervention with the provision of dynamic imaging which is crucial for providing safe and effective patient management.
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Affiliation(s)
- Alexander Lory
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, St James’ University Hospital, Leeds Teaching Hospitals NHS
Trust, Leeds, UK
| | - Christopher Stubbs
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, St James’ University Hospital, Leeds Teaching Hospitals NHS
Trust, Leeds, UK
| | - Stephen Wolstenhulme
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, St James’ University Hospital, Leeds Teaching Hospitals NHS
Trust, Leeds, UK
| | - Atif Khan
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, St James’ University Hospital, Leeds Teaching Hospitals NHS
Trust, Leeds, UK
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Al-Hajjaj M, Sabbagh AJ, Al-Hadid I, Anan MT, Nour kazan M, Alali Aljool A, AL Muhammad AL Husein H, Tallaa M. Comparison complications rate between double-J ureteral stent and percutaneous nephrostomy in obstructive uropathy due to stone disease:A randomized controlled trial. Ann Med Surg (Lond) 2022; 81:104474. [PMID: 36147143 PMCID: PMC9486745 DOI: 10.1016/j.amsu.2022.104474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 11/15/2022] Open
Abstract
Background Obstructive uropathy due to stone disease is seen every day in urological practice. Percutaneous nephrostomy and double j ureteral stent procedures are used. Methodology A randomized controlled trial was conducted in one center from January 2021 to January 2022. A total of 104 patients of age ≥18 years who had unilateral or bilateral obstructive uropathy due to stone disease were divided into two groups. In Group A, 50 patients underwent to double j stent while in Group B, 54 patients who underwent percutaneous nephrostomy insertion tube. Under local anesthesia, the stent was inserted by cystoscopy. While the percutaneous nephrostomy was done under ultrasound guidance by using local anesthetic agent. Complications were noted in immediate postoperative period and on follow up. Results Mean age of Group A was 35 ± 12.7 years whereas mean age in Group B was 36.7 ± 12.5 years and 49 out of patients were male. The most common complication in double j group and nephrostomy group was hematuria (16% and 5.5% respectively). Post DJ stent, complications like septicemia, painful trigon irritation, and stent encrustation were seen in 8.0%, 10.0%, 10.0% and 4.0% patients respectively. On the other hand, post-PCN septicemia, tube dislodgment or blockage, and injury to adjacent organs were seen in 3.7%, 5.5% and 1.8% respectively. In our trial, overall success rate for double j stenting was up to 84.0% and for percutaneous nephrostomy (PCN) was 96.29% (p < 0.0001). Conclusion We found percutaneous nephrostomy is better and had overall higher success rate with less complications post procedure. Obstructive uropathy is a common urological condition seen in urology. Stone disease is the most common cause of obstructive uropathy. Percutaneous nephrostomy and retrograde double j stent are common procedures for reliving the urological obstruction. To these days, there is superiority of one procedure on the other. In addition, no clear guideline support one procedure instead the other.
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12
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Haghpanah A, Ahmed F, Hosseini SH, Mashayekh A, Dehghani A, Rastin S. Peritoneal perforation and peritonitis after antegrade double-J stent insertion: A case report and review of the literature. Clin Case Rep 2022; 10:e05436. [PMID: 35169472 PMCID: PMC8831974 DOI: 10.1002/ccr3.5436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
Penetration of peritoneal cavity during antegrade double-J (DJ) stenting is rare. A 52-year-old woman presented with signs of peritonitis for 3 days after left PCNL. Abdominal CT scan revealed a perforation of the peritoneum by the distal coil of DJ stent, which was reinserted into the bladder by ureteroscopy.
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Affiliation(s)
- Abdolreza Haghpanah
- Department of UrologySchool of MedicineShiraz University of Medical SciencesShirazIran
| | - Faisal Ahmed
- Urology Research CenterDepartment of UrologySchool of MedicineAl‐Thora General HospitalIbb University of Medical SinceIbbYemen
| | | | - Ali Mashayekh
- Department of UrologySchool of MedicineShiraz University of Medical SciencesShirazIran
| | - Anahita Dehghani
- Shiraz Nephro‐Urology Research CenterShiraz University of Medical SciencesShirazIran
| | - Sourena Rastin
- Department of UrologySchool of MedicineShiraz University of Medical SciencesShirazIran
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Emam A, Elmoazen M, Shabayek M, Zriek AM, Gad HH. Evaluation of Galdakao-modified Valdivia position in endoscopic management of malignant ureteric obstruction. Int Urol Nephrol 2022; 54:463-468. [PMID: 35084651 PMCID: PMC8831257 DOI: 10.1007/s11255-022-03109-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/31/2021] [Indexed: 11/30/2022]
Abstract
Background Malignant ureteric obstruction (MUO) due to pelvic malignancies is challenging for endourological management and carries high failure rates for retrograde cystoscopic ureteric stenting. Methods We adopted Galdakao-modified Valdivia (GMV) position in the management of MUO in an operating room equipped with a C-arm fluoroscopy unit and an ultrasound device. We prospectively studied the added value of this approach in 50 cases who failed retrograde ureteric stenting. Results Thirty-seven (74%) cases were done under a high level of spinal anesthesia. Mean operative time was 62 min. Antegrade ureteric stenting succeeded in 45/50 (90%) patients who failed retrograde ureteric stenting. GMV position facilitated simultaneous retrograde and antegrade management of MUO. Eight patients (16%) underwent auxiliary cystoscopic procedures to reduce the mass over the ureteric orifice (UO) guided by antegrade methylene blue or over a probing antegrade guidewire. Nephrostomy tube was inserted in the same setting in 16/50 (32%) cases. Antegrade flow of contrast to the bladder (P < 0.001) and ureteric kinks rather than tight stenosis or infiltration of UO (P = 0.014) were significantly associated with the success of antegrade ureteric stenting. No major complications were encountered. Conclusion GMV position is an ideal choice for management of MUO as it allows simultaneous access to the lower and the upper urinary systems to accomplish ureteric stenting either in a retrograde or an antegrade fashion as well as the ability to insert a nephrostomy tube in the same setting, thus shortening the inpatient care and this should be the standard of care in cases with MUO.
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Affiliation(s)
- Ahmed Emam
- Department of Urology, Ain Shams University, 38 Abbasia, Cairo, 11591 Egypt
| | - Mohamed Elmoazen
- Department of Urology, Ain Shams University, 38 Abbasia, Cairo, 11591 Egypt
| | - Mohamed Shabayek
- Department of Urology, Ain Shams University, 38 Abbasia, Cairo, 11591 Egypt
| | - Amr M. Zriek
- Department of Urology, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Hany Hamed Gad
- Department of Urology, Ain Shams University, 38 Abbasia, Cairo, 11591 Egypt
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Lu H, Zheng C, Liang B, Xiong B. Analysis of long-term effect of ureteral balloon dilatation combined with internal and external drainage tube in the treatment of benign ureteral stricture. BMC Urol 2022; 22:4. [PMID: 35027021 PMCID: PMC8759268 DOI: 10.1186/s12894-022-00952-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 01/04/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE There are few reports about balloon dilatation combined with internal and external drainage tube in the treatment of ureteral stricture under interventional therapy. The aim of the study is to explore the safety, effectiveness and long-term efficacy of this treatment strategy. MATERIALS AND METHODS It is a retrospective and observational study. From October 2013 to October 2016, 42 patients with benign lower ureteral stricture received interventional treatment. Balloon dilatation combined with internal and external drainage tube implantation were used. There were 25 male patients and 17 female patients. There were 7 cases (16.7%) with congenital ureteral stricture, 12 cases (28.6%) with inflammation, 15 cases (35.7%) with ureteral stricture after lithotomy or lithotripsy, and 8 cases (19.0%) with ureteral stricture after pelvic or abdominal surgery. After the drainage tube was removed, B ultrasound, enhanced CTU or IVP of urinary system were reexamined every six months. The follow-up time was 12-60 months. RESULTS The age was 52.9 ± 11.6 years. The length of ureteral stricture was 1.1 ± 0.5 cm. 42 patients completed interventional treatment, the technical success rate was 100%, no ureteral perforation, rupture or other complications were identified. Preoperative urea nitrogen 9.2 ± 2.3 mmol/L and creatinine 175.8 ± 82.8umol/L. Urea nitrogen and creatinine were 3.8-9.1 mmol/L and 45.2-189.6 umol/L when removing the drainage tube. There were significant differences in the levels of urea nitrogen and creatinine before and after tube removal (P < 0.05). The ureteral patency rate was 100% at 6 months, 93% at 12 months, 83% at 18 months, 79% at 24 months, 76% at 30 months and 73% at 36-60 months. The overall success rate was 73%. Multivariate Cox regression analysis showed that stenosis length was a risk factor for postoperative patency (P < 0.05). CONCLUSION Balloon dilatation combined with internal and external drainage tube implantation in the treatment of benign lower ureteral stricture is safe and effective.
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Affiliation(s)
- Haohao Lu
- Interventional Therapy Department, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022 China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022 China
| | - Chuansheng Zheng
- Interventional Therapy Department, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022 China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022 China
| | - Bin Liang
- Interventional Therapy Department, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022 China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022 China
| | - Bin Xiong
- Interventional Therapy Department, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022 China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022 China
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Palm CA, Canvasser NE, Culp WTN. Stenting of Malignant Urinary Tract Obstructions in Humans and Companion Animals. Vet Sci 2021; 9:vetsci9010013. [PMID: 35051097 PMCID: PMC8780232 DOI: 10.3390/vetsci9010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/23/2021] [Accepted: 12/25/2021] [Indexed: 11/30/2022] Open
Abstract
Urine retention secondary to neoplastic obstructions of the upper and lower urinary tracts is a life-threatening condition in both humans and companion animals. Stents can be placed to temporarily or permanently open obstructed urinary tract lumens and are often able to be placed using minimally invasive techniques with guidance via ultrasonography or fluoroscopy. The literature for these techniques is vast for humans and growing for companion animals. The below review provides a discussion of the principles of stenting and types of ureteral and urethral stents, as well as the techniques for placing these stents in humans and companion animals.
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Affiliation(s)
- Carrie A. Palm
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616, USA
- Correspondence: (C.A.P.); (W.T.N.C.)
| | - Noah E. Canvasser
- Department of Urologic Surgery, University of California-Davis Medical Center, Sacramento, CA 95817, USA;
| | - Willian T. N. Culp
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616, USA
- Correspondence: (C.A.P.); (W.T.N.C.)
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Medina-Polo J, Naber KG, Bjerklund Johansen TE. Healthcare-associated urinary tract infections in urology. GMS INFECTIOUS DISEASES 2021; 9:Doc05. [PMID: 34540531 PMCID: PMC8422970 DOI: 10.3205/id000074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The purpose of the present review is to report the incidence and characteristics of healthcare-associated urinary tract infections (HAUTIs) in urology with their microbiological and resistance patterns. Urinary tract infections are the main type of healthcare-associated infection in patients hospitalized in a urology ward. Patients admitted to urology departments report a high prevalence of urinary tract catheterization, up to 75% during the hospitalization period, and up to 20% had a urinary catheter before admission. An endourological surgical procedure is another risk factor for HAUTIs. Other risk factors for HAUTIs are the presence of immunosuppression and previous urinary tract infections. In urological patients, Enterobacterales are the principal causative agent of HAUTIs, and E. coli is the most frequently isolated microorganism. However, there is also a high rate of microorganisms other than E. coli such as Klebsiella spp. and Enterococcus spp. Non-E. coli microorganisms show a higher prevalence in immunosuppressed patients and those with urinary catheters before admission. High resistance patterns are reported in patients with HAUTIs, and ESBL-producing bacteria are frequently described. Moreover, the isolation of multidrug-resistant microorganisms is more common in immunosuppressed patients, those with previous urinary tract infections, and urinary catheters into the upper urinary tract. Treatment must be tailored according to patient characteristics and patient profiles, bearing in mind the ORENUC classification for risk factors (no risk factors (O), recurrent urinary tract infections risk factors (R), extraurogenital risk factors (E), nephropathic disease (N), urological risk factors (U), permanent urinary catheter and non-resolvable urological risk factors (C)).
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Affiliation(s)
- José Medina-Polo
- Department of Urology, Health Research Institute i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Kurt G Naber
- Department of Urology, Technical University of Munich, Germany
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Medina-Polo J, Gil-Moradillo J, González-Díaz A, Abad-López P, Santos-Pérez de la Blanca R, Hernández-Arroyo M, Peña-Vallejo H, Téigell-Tobar J, Calzas-Montalvo C, Caro-González P, Miranda-Utrera N, Tejido-Sánchez Á. Observational study over 8-year period evaluating microbiological characteristics and risk factor for isolation of multidrug-resistant organisms (MDRO) in patients with healthcare-associated infections (HAIs) hospitalized in a urology ward. GMS INFECTIOUS DISEASES 2021; 9:Doc04. [PMID: 34540530 PMCID: PMC8422969 DOI: 10.3205/id000073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective: To analyze, in a urology ward, the prevalence and characteristics of healthcare-associated infections (HAIs) due to multidrug-resistant organisms (MDRO). Methods: We carried out an observational study from 2012 to 2019, evaluating MDRO among patients with HAIs, who were hospitalized in the urology ward. MDRO include Pseudomonas spp., resistant to at least three antibiotic groups, extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae or those resistant to carbapenems, and Enterococcus spp. resistant to vancomycin. Results: Among patients with HAIs, MDRO were isolated in 100 out of 438 (22.8%) positive cultures. Univariate and multivariate analyses reported that prior urinary tract infection (UTI) [OR 2.45; 95% CI 1.14-5.36; p=0.021] and immunosuppression [OR 2.13; 95% CI 1.11-4.10; p=0.023] were risk factors for MDRO. A high prevalence of MRDO was found in patients with a catheter in the upper urinary tract; 27.6% for double J stent, 29.6% in those with a nephrostomy tube, and 50% in those with a percutaneous internal/external nephroureteral (PCNU) stent. MDRO were isolated in 28.4% of cultures with Enterobacteriaceae (23.8% and 44.7% in those with E. coli and Klebsiella spp.); 7% of Enterobacteriaceae showed resistance to carbapenems (1.3% and 10% for E. coli and Klebsiella spp., respectively). Three out of 80 Enterococcus spp. were vancomycin-resistant. The rate of Pseudomonas aeruginosa resistant to at least three antibiotic groups was 36.3%. Conclusions: The isolation of MDRO, in up to 25% of positive cultures in a urology ward, constitutes a challenge for the selection of antibiotics. MDRO are more common in immunosuppressed patients, those with previous UTIs, and those with a catheter in the upper urinary tract.
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Affiliation(s)
- José Medina-Polo
- Department of Urology, Health Research Institute i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Javier Gil-Moradillo
- Department of Urology, Health Research Institute i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alejandro González-Díaz
- Department of Urology, Health Research Institute i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Pablo Abad-López
- Department of Urology, Health Research Institute i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Mario Hernández-Arroyo
- Department of Urology, Health Research Institute i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Helena Peña-Vallejo
- Department of Urology, Health Research Institute i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Julio Téigell-Tobar
- Department of Urology, Health Research Institute i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Cristina Calzas-Montalvo
- Department of Urology, Health Research Institute i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Prado Caro-González
- Department of Urology, Health Research Institute i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Natalia Miranda-Utrera
- Department of Urology, Health Research Institute i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ángel Tejido-Sánchez
- Department of Urology, Health Research Institute i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
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Dimitrijevic Z, Paunovic G, Tasic D, Mitic B, Basic D. Risk factors for urosepsis in chronic kidney disease patients with urinary tract infections. Sci Rep 2021; 11:14414. [PMID: 34257397 PMCID: PMC8277778 DOI: 10.1038/s41598-021-93912-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/29/2021] [Indexed: 01/04/2023] Open
Abstract
Occurrence of urosepsis is not uncommon following urinary tract infections (UTI). However, there is a lack of evidence explaining the risk factors predisposing to urosepsis in patients with chronic kidney disease (CKD). This retrospective study was undertaken to evaluate the incidence and possible risk factors for urosepsis among patients hospitalized with UTI in a cohort of CKD patients. Patients were divided into the urosepsis group and the non-urosepsis group. Of 489 hospitalized patients with UTI, 70 (14.3%) acquired urosepsis. Stepwise multivariate logistic regression demonstrated that diabetes, urinary catheter and length of hospital stay (p < 0.001 for all) were significant independent predictive risk factors for urosepsis in CKD patients with UTI in addition to age, glomerular filtration rate, hydronephrosis, acute kidney injury and E. coli infection (p < 0.05 for all). Finally, Klebsiella spp. cases were associated with significantly higher odds for urosepsis than E. coli cases (OR: 3.5, 95% CI: 2.86-7.23, p < 0.001 vs. OR: 1.38, 95% CI: 1.19-3.69, p = 0.038). Diabetes, presence of an indwelling urinary catheter, length of hospitalization, and infection with Klebsiella spp were independent risk factors for urosepsis in CKD patients with UTI.
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Affiliation(s)
- Zorica Dimitrijevic
- Faculty of Medicine, University of Nis, Bulevar Dr. Z. Djindjica 81, 18000, Niš, Serbia.
- Clinic for Nephrology, Clinical Center Nis, Bulevar Dr. Z. Djindjica 48, 18000, Niš, Serbia.
| | - Goran Paunovic
- Clinic for Nephrology, Clinical Center Nis, Bulevar Dr. Z. Djindjica 48, 18000, Niš, Serbia
| | - Danijela Tasic
- Clinic for Nephrology, Clinical Center Nis, Bulevar Dr. Z. Djindjica 48, 18000, Niš, Serbia
| | - Branka Mitic
- Faculty of Medicine, University of Nis, Bulevar Dr. Z. Djindjica 81, 18000, Niš, Serbia
- Clinic for Nephrology, Clinical Center Nis, Bulevar Dr. Z. Djindjica 48, 18000, Niš, Serbia
| | - Dragoslav Basic
- Faculty of Medicine, University of Nis, Bulevar Dr. Z. Djindjica 81, 18000, Niš, Serbia
- Clinic for Urology, Clinical Center Nis, Bulevar Dr. Z. Djindjica 48, 18000, Niš, Serbia
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19
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Nas OF, Oztepe MF, Kandemirli SG, Bilgin C, Ozkaya G, Inecikli MF, Kaygısız O. Predictors of antegrade ureteral stenting failure: a single-center experience in patients with malignant and benign ureteral obstruction. Abdom Radiol (NY) 2021; 46:2188-2194. [PMID: 33226456 DOI: 10.1007/s00261-020-02858-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/09/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the potential predictors of antegrade ureteral stenting (AUS) failure in patients with malignant and benign ureteral obstruction. METHOD We retrospectively evaluated 116 AUS procedures performed in 80 patients for ureteral obstruction due to malignant and benign causes. Variables such as etiology for obstruction, ureter shape, previous treatment regimen, history of ileal loop diversion, and presence of percutaneous nephrostomy were recorded. Univariate and multivariate logistic regression methods were used between these variables and stent failure. RESULTS Antegrade ureteral stenting was performed as single stage in 24 procedures (n: 24/116, 21%) and performed as a two-step approach after percutaneous nephrostomy in 92 procedures (n: 92/116, 79%). Ureteral stent was successfully deployed in 112 AUS procedures (n: 112/116, 96.5%). In 35 of these successful procedures, the patients were referred to our department due to prior failed retrograde ureteral stenting (RUS). Subsequent stent failure occurred in 40 procedures after a median interval of 39 days. Pre-stenting percutaneous nephrostomy (PN) was a statistically significant risk factor for stent failure (p: 0.041), and age showed an inverse relationship with stent failure (p: 0.008). Complications in early (within the first 30 days after procedure) and late stage occurred in a total of 17 procedures. Early complications included urinary tract infection (n: 11), stent migration (n: 3), and malposition (n: 1). Late complications (after 30 days) were urinary tract infection (n: 1) and stent migration (n: 1). CONCLUSION This study suggests that AUS can be performed effectively in both benign and malignant ureteral obstructions including cases with prior failed RUS. Two-step AUS after percutaneous nephrostomy was found to be a significant risk factor for subsequent stent failure in our study cohort.
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20
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Wang C, Calle P, Tran Ton NB, Zhang Z, Yan F, Donaldson AM, Bradley NA, Yu Z, Fung KM, Pan C, Tang Q. Deep-learning-aided forward optical coherence tomography endoscope for percutaneous nephrostomy guidance. BIOMEDICAL OPTICS EXPRESS 2021; 12:2404-2418. [PMID: 33996237 PMCID: PMC8086467 DOI: 10.1364/boe.421299] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 05/18/2023]
Abstract
Percutaneous renal access is the critical initial step in many medical settings. In order to obtain the best surgical outcome with minimum patient morbidity, an improved method for access to the renal calyx is needed. In our study, we built a forward-view optical coherence tomography (OCT) endoscopic system for percutaneous nephrostomy (PCN) guidance. Porcine kidneys were imaged in our experiment to demonstrate the feasibility of the imaging system. Three tissue types of porcine kidneys (renal cortex, medulla, and calyx) can be clearly distinguished due to the morphological and tissue differences from the OCT endoscopic images. To further improve the guidance efficacy and reduce the learning burden of the clinical doctors, a deep-learning-based computer aided diagnosis platform was developed to automatically classify the OCT images by the renal tissue types. Convolutional neural networks (CNN) were developed with labeled OCT images based on the ResNet34, MobileNetv2 and ResNet50 architectures. Nested cross-validation and testing was used to benchmark the classification performance with uncertainty quantification over 10 kidneys, which demonstrated robust performance over substantial biological variability among kidneys. ResNet50-based CNN models achieved an average classification accuracy of 82.6%±3.0%. The classification precisions were 79%±4% for cortex, 85%±6% for medulla, and 91%±5% for calyx and the classification recalls were 68%±11% for cortex, 91%±4% for medulla, and 89%±3% for calyx. Interpretation of the CNN predictions showed the discriminative characteristics in the OCT images of the three renal tissue types. The results validated the technical feasibility of using this novel imaging platform to automatically recognize the images of renal tissue structures ahead of the PCN needle in PCN surgery.
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Affiliation(s)
- Chen Wang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73072, USA
- These authors contributed equally to this work
| | - Paul Calle
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73072, USA
- These authors contributed equally to this work
| | - Nu Bao Tran Ton
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73072, USA
| | - Zuyuan Zhang
- School of Computer Science, University of Oklahoma, Norman, OK 73072, USA
| | - Feng Yan
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73072, USA
| | - Anthony M Donaldson
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73072, USA
| | - Nathan A Bradley
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Zhongxin Yu
- Children's Hospital, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Kar-Ming Fung
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Chongle Pan
- School of Computer Science, University of Oklahoma, Norman, OK 73072, USA
| | - Qinggong Tang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73072, USA
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Colakerol A, Temiz MZ, Adem MB, Ozdogan K, Celebi F, Kandirali E, Muslumanoglu AY. Conservative Management of the Duodenal Injury during Percutaneous Nephrostomy Placement: A Few and Far between Complications of the Urological Literature. Case Rep Urol 2021; 2021:8221488. [PMID: 35003821 PMCID: PMC8741385 DOI: 10.1155/2021/8221488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/30/2021] [Accepted: 12/10/2021] [Indexed: 02/07/2023] Open
Abstract
Herein, we reported a duodenal perforation case as an intestinal injury during a percutaneous nephrostomy procedure. A 73-year-old woman with bilateral nephrostomy catheters was applied to the emergency service with right flank pain. Early in the day, her bilateral nephrostomy catheters had been changed. On physical examination, she had a defense and rebound at her right quadrant, and costovertebral angle tenderness was also positive. In the contrast-enhanced abdominal computed tomography scan, the right nephrostomy catheter was located in the second part of the duodenum, and the contrast agent did not leak into the peritoneum from the injury area. We decided on conservative management of the case with active surveillance using daily blood tests and physical examinations. The nephrostomy catheter in the duodenum was left to prevent fistula between the duodenum and the skin, and a new one was placed in the right kidney. The broad spectrum antibiotherapy regime was applied, and the patient was followed up closely. The catheter in the duodenum was removed on the 20th day, uneventfully, and the patient was discharged successfully on the 24th day with her permanent bilateral nephrostomy tubes. On the first follow-up, one month later, the patient had no active medical complaint.
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Affiliation(s)
- Aykut Colakerol
- 1Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Zafer Temiz
- 1Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Mubarek Bargicho Adem
- 2Department of General Surgery, Urology Unit, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Kamil Ozdogan
- 3Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Fatih Celebi
- 3Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Engin Kandirali
- 1Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
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Djajadiningrat RS, Walz J, van Dijk LC, Roshani H. Antegrade pyelography, a survey among urologists. Ir J Med Sci 2020; 189:843-848. [DOI: 10.1007/s11845-020-02180-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 01/21/2020] [Indexed: 12/01/2022]
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23
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Medina-Rico M, Zárate-Velasco AM, Quiñonez A, López-Ramos H. Sexuality in People With Ostomies: A Literature Review. SEXUALITY AND DISABILITY 2019. [DOI: 10.1007/s11195-019-09604-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hynes D, Aghajafari P, Janne d'Othée B. Role of Interventional Radiology in the Management of Infection. Semin Ultrasound CT MR 2019; 41:20-32. [PMID: 31964492 DOI: 10.1053/j.sult.2019.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Interventional radiology (IR) is plays a crucial role in the management of localized infections, utilizing percutaneous access to loculated fluid collections for drainage and source control. Interventions have been developed in multiple organs and systems and used over decades, allowing the IR physician to provide patient care in many cases where surgical options are not optimal. In this review, we will examine the emergent, urgent, and routine nature of various IR procedures in the infectious context and timelines for each in regards to the decision making process. An algorithmic approach should guide the clinician's decision making for IR procedures in both large academic centers and smaller community hospitals. This approach and the pertinent procedural technique are described for multiple systems and organs including the biliary tree, gallbladder, genitourinary tract, and thoracic, abdominal, and pelvic abscesses. Increased awareness of the abilities and limitations of IR physicians in clinical scenarios needs to be implemented, to allow multispecialty input in efforts to decrease morbidity and mortality.
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Affiliation(s)
- Daniel Hynes
- University of Massachusetts Medical School- Baystate Medical Center, Division of Interventional Radiology, Springfield, MA.
| | - Pouya Aghajafari
- University of Massachusetts Medical School- Baystate Medical Center, Division of Interventional Radiology, Springfield, MA
| | - Bertrand Janne d'Othée
- University of Massachusetts Medical School- Baystate Medical Center, Division of Interventional Radiology, Springfield, MA
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25
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Fernández-Cacho LM, Ayesa-Arriola R. Quality of life, pain and anxiety in patients with nephrostomy tubes. Rev Lat Am Enfermagem 2019; 27:e3191. [PMID: 31596421 PMCID: PMC6781322 DOI: 10.1590/1518-8345.3039.3191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 06/11/2019] [Indexed: 02/08/2023] Open
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.
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Affiliation(s)
| | - Rosa Ayesa-Arriola
- Hospital Marqués de Valdecilla University, Department of Psychiatry, Santander,Cantabria, Spain.,Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain.,University Of Cantabria, School of Medicine, Santander, Cantabria, Spain.,Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), Spain
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Kahriman G, Özcan N, Doğan A, İmamoğlu H, Demirtaş A. Percutaneous antegrade ureteral stent placement: single center experience. ACTA ACUST UNITED AC 2019; 25:127-133. [PMID: 30860076 DOI: 10.5152/dir.2019.18252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to present our clinical experience with percutaneous antegrade ureteral stent placement in a single center. METHODS Electronic records of patients who underwent percutaneous image-guided ureteral stent placement between September 2005 and April 2017 were reviewed. A total of 461 patients (322 males, 139 females; age range, 19-94 years; mean age, 61.4±15 years) were included in the study. Patients were classified into two main groups: those with neoplastic disease and those with non-neoplastic disease. Failure was defined as persistence of high level of serum creatinine or an inability to place stents percutaneously. Postprocedural complications were grouped as percutaneous nephrostomy and stent placement related complications. RESULTS A total of 727 procedures in 461 patients were included in the study: 654 procedures (90%) in 407 patients (88.3%) were in the neoplastic group and 73 procedures (10%) in 54 patients (11.7%) were in the non-neoplastic group. Our technical success rates were 97.7% and 100% and complication rates were 3.1% and 4.1% in neoplastic and non-neoplastic groups, respectively. Seven stents retrievals and 112 balloon dilatations were performed successfully. CONCLUSION Percutaneous antegrade ureteral stent placement is a safe and effective method for management of ureteral injuries and obstructions due to both malignant and benign causes when the retrograde approach has failed.
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Affiliation(s)
- Güven Kahriman
- Departments of Radiology, Erciyes University School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Nevzat Özcan
- Departments of Radiology, Erciyes University School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Aytaç Doğan
- Departments of Radiology, Erciyes University School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Hakan İmamoğlu
- Departments of Radiology, Erciyes University School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Abdullah Demirtaş
- Departments of Urology, Erciyes University School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
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Meira MDS, Barbosa PNVP, Bitencourt AGV, Almeida MFA, Tyng CJ, Costa MAF, Góes ACDA, Chojniak R. Retrospective analysis of computed tomography-guided percutaneous nephrostomies in cancer patients. Radiol Bras 2019; 52:148-154. [PMID: 31210686 PMCID: PMC6561362 DOI: 10.1590/0100-3984.2018.0023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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.
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Affiliation(s)
| | | | | | | | - Chiang Jeng Tyng
- Department of Imaging, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | | | | | - Rubens Chojniak
- Department of Imaging, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
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Complicated urinary tract infection by Trichosporon loubieri. Med Mycol Case Rep 2019; 24:86-89. [PMID: 31080715 PMCID: PMC6506559 DOI: 10.1016/j.mmcr.2019.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/20/2019] [Accepted: 04/24/2019] [Indexed: 12/01/2022] Open
Abstract
We report two cases of complicated Urinary Tract Infection, one with nephrostomy tube left in-situ and other with bladder outlet obstruction, caused by Trichosporon loubieri. Both patients responded well to antifungal treatment along with change/removal of catheters. In both the cases, correct identification of T. loubieri was done by IGS1 sequencing. Prompt identification and timely management headed to good clinical outcome. Hence, clinicians should be aware of T. loubieri as an emerging fungi causing human infections.
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Liu Y, Wu K, Lai H, Zeng Z, Zhang B. Clinical application of fluoroscopic guided percutaneous antegrade ureteral stents placement for the treatment of malignant ureteral obstruction. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:453-460. [PMID: 30909269 DOI: 10.3233/xst-180466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate the clinical efficacy and safety of fluoroscopic guided percutaneous antegrade ureteral stents placement used for treatment of malignant ureteral obstruction. METHODS Between April 2016 and March 2018, fluoroscopic guided percutaneous ureteral stents was performed in 25 patients, including 7 patients (28%) with bilateral obstruction. The most common cancer diagnoses were cervical cancer (28%), rectal cancer (24%) and colon cancer (16%) among these patients. Clinical data were retrospectively analyzed with respect to the efficacy, safety and outcome of this treatment method. RESULTS Percutaneous antegrade placement of ureteral stents was performed in all cases, including 12 ureters that failed in the initial retrograde ureteral stents placement. The median stent patency time for the antegrade ureteral stents were 10.4 (95% CI: 8.3-12.6) months. The primary complications included mild flank pain and discomfort (44%), hematuria (44%), urinary tract infection (8%), bladder irritation symptoms (4%), and arterial bleeding (4%). CONCLUSION Fluoroscopic guided percutaneous ureteral stents placement is a safe, efficient procedure and has a high success rate in patients with malignant ureteral obstruction.
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Affiliation(s)
- Yang Liu
- Department of Radiology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ketong Wu
- Department of Radiology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haiyang Lai
- Department of Radiology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhaofei Zeng
- Department of Radiology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bo Zhang
- Department of Radiology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Howlader A, Thajudeen B, Kodali L, Martin D, Harland R, Roy-Chaudhury P. Page Kidney Following Nephroureteral Stent Placement in a Renal Transplant Allograft. Prog Transplant 2018; 29:95-96. [DOI: 10.1177/1526924818817014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Anjuman Howlader
- Department of Nephrology, Banner University of Arizona Medical Center, Tucson, AZ, USA
| | - Bijin Thajudeen
- Department of Nephrology, Banner University of Arizona Medical Center, Tucson, AZ, USA
| | - Lavanya Kodali
- Department of Nephrology, Banner University of Arizona Medical Center, Tucson, AZ, USA
| | - Diego Martin
- Department of Medical Imaging, Banner University of Arizona Medical Center, Tucson, AZ, USA
| | - Robert Harland
- Department of Transplant Surgery, Banner University of Arizona Medical Center, Tucson, AZ, USA
| | - Prabir Roy-Chaudhury
- Department of Nephrology, Banner University of Arizona Medical Center, Tucson, AZ, USA
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Epidemiology of Nephrostomy Tube–Related Urinary Tract Infections Among US Veterans. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2018. [DOI: 10.1097/ipc.0000000000000663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Comparison of single and tandem ureteral stenting for malignant ureteral obstruction: a prospective study of 104 patients. Eur Radiol 2018; 29:628-635. [PMID: 29974220 DOI: 10.1007/s00330-018-5560-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/11/2018] [Accepted: 05/23/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of this study was to compare single and tandem ureteral stenting in the management of malignant ureteral obstruction (MUO). METHODS Our hospital's institutional review board approved this prospective study. Between November 2014 and June 2017, single ureteral stenting was performed in 56 patients (94 renal units) and tandem ureteral stenting in 48 patients (63 renal units) for MUO. A comparative analysis of the technical success rate, patient survival, stent patency, and complications was performed. RESULTS Similar demographic data were observed in patients receiving either single or tandem ureteral stenting. The technical success rate was 93.6% (88/94) for single ureteral stenting and 95.2% (60/63) for tandem ureteral stenting. There was no difference in overall survival between patients receiving single or tandem ureteral stenting (p = 0.41), but the duration of stent patency in tandem ureteral stenting was significantly longer (p = 0.022). The mean patency time was 176.7 ± 21.3 days for single ureteral stenting, and 214.7 ± 21.0 days for tandem ureteral stenting. The complications of ureteral stenting were urinary tract infection (n = 18), lower urinary tract symptoms (n = 5), haematuria (n = 3), and stent migration (n = 1). CONCLUSIONS Tandem ureteral stenting is a safe and feasible treatment for MUO, and had better efficacy compared to single ureteral stenting. KEY POINTS • Ureteral stenting is an established treatment for the management of malignant ureteral obstruction (MUO) • Prospective single-centre study showed that tandem ureteral stenting is a safe and feasible treatment for MUO • Tandem ureteral stenting provides longer stent patency compared to single ureteral stenting in patient with MUO.
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Abstract
The kidneys are paired intra-abdominal organs which provide essential functions and maintain homeostasis throughout the human body. Numerous disease processes affect the kidneys and cause acute renal dysfunction or other potentially catastrophic complications. These conditions can be broadly categorized into obstructive, infectious, hemorrhagic, traumatic, and vascular diseases. Imaging plays a vital role in the work-up and diagnosis of acute and emergent renal conditions. Evaluation of emergent renal conditions with a focus on CT imaging is discussed.
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Affiliation(s)
- Kunal Kothari
- Department of Radiology, Hofstra Northwell School of Medicine, New Hyde Park, NY.
| | - John J Hines
- Department of Radiology, Hofstra Northwell School of Medicine, New Hyde Park, NY
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Kuetting D, Meyer C, Schild HH, Pieper CC. In Vitro Evaluation of the Occlusive Properties of the ArtVentive Endoluminal Occlusion System Occlusion Device for Transrenal Ureteral Occlusion. J Endourol 2017; 31:1084-1089. [PMID: 28816077 DOI: 10.1089/end.2017.0493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Current techniques for percutaneous ureteral occlusion are either technically difficult or not satisfactory because of frequent ureteral recanalization. The purpose of this in vitro study was to evaluate the occlusive properties of an "off the shelf" solution (Endoluminal Occlusion System [EOS™]; ArtVentive Medical Group, Inc., Carlsbad, CA) for transrenal ureteral occlusion. MATERIALS AND METHODS Both 8 and 11 mm expanded polytetrafluoroethylene-covered ArtVentive EOS devices were used in 10 porcine models. Experiments were performed in explanted porcine ureters to simulate physiologic conditions. EOS devices were deployed in a midureteral position using a transrenal approach. Contrast agent (Iopamidol 300) diluted in saline solution was infused into the renal pelvis under continuous fluoroscopic guidance. Intrapelvic pressure measurements were performed until leakage, plug dislocation, or until pelvic blow out occurred. RESULTS All EOS devices were deployed effectively and achieved prompt total ureteral occlusion. Ureteral leakage occurred with intraureteral pressures between 60 to 109 cm H2O (8 mm EOS) and between 65 and 125 cm H2O (11 mm EOS). Before leakage, tubular reflux was seen in all cases, pelvic blowout occurred in half of the cases. CONCLUSIONS The ArtVentive EOS occlusive device is an effective tool for "off the shelf" ureteral occlusion. Both the 8 mm and the 11 mm devices fully occluded ureters at pressure levels that are to be expected in vivo.
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Affiliation(s)
| | - Carsten Meyer
- Department of Radiology, University of Bonn , Bonn, Germany
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Primary and Secondary Percutaneous Ureteral Stent Placement: Comparison of Stent Patency and Clinical Outcome. Cardiovasc Intervent Radiol 2017; 41:130-136. [PMID: 28707094 DOI: 10.1007/s00270-017-1744-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To compare early double J ureteral stent (DJUS) dysfunction rate and long-term patency between two percutaneous ureteral stent placement methods: single-stage (primary) or two-stage (secondary) procedures. METHODS A total of 250 (176 primary and 74 secondary) DJUS placements performed on interventional unit were retrospectively reviewed between February 2008 and March 2014. Early DJUS dysfunction was defined as no passage of contrast media into the urinary bladder in 2-3 days after placement. Long-term patency was considered if the ureteral stent functioned for 3 months (time point for a first routine DJUS change). Amount of blood retained in the collecting system was scored on nephrostogram immediately after DJUS placement with three levels of score. RESULTS The overall early DJUS dysfunction rate and long-term patency rate were 30.8 and 96.7%. The early DJUS dysfunction rates were similar in primary and secondary DJUS placements (30.7 and 31.1%, P = 0.950). The long-term patency rates were similar in primary and secondary groups (96.2 and 97.9%, P = 0.928). The amount of blood retained in the collecting system between primary and secondary groups was not significantly different. The early DJUS dysfunction rate significantly increased with increasing blood retention. CONCLUSIONS The early DJUS dysfunction rates and long-term patency are similar in primary and secondary DJUS placement. However, the early DJUS dysfunction rate can be increased by increasing the blood retention in the collecting system.
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In Vitro Study of Antimicrobial Percutaneous Nephrostomy Catheters for Prevention of Renal Infections. Antimicrob Agents Chemother 2017; 61:AAC.02596-16. [PMID: 28320713 DOI: 10.1128/aac.02596-16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/03/2017] [Indexed: 01/28/2023] Open
Abstract
Percutaneous nephrostomy (PCN) catheters are the primary method for draining ureters obstructed by malignancy and preventing a decline of renal function. However, PCN catheter-related infections, such as pyelonephritis and urosepsis, remain a significant concern. Currently, no antimicrobial PCN catheters are available for preventing infection complications. Vascular catheters impregnated with minocycline-rifampin (M/R) and M/R with chlorhexidine coating (M/R plus CHD) have previously demonstrated antimicrobial activity. Therefore, in this study, we examined whether these combinations could be applied to PCN catheters and effectively inhibit biofilm formation by common uropathogens. An in vitro biofilm colonization model was used to assess the antimicrobial efficacy of M/R and M/R-plus-CHD PCN catheters against nine common multidrug-resistant Gram-positive and Gram-negative uropathogens as well as Candida glabrata and Candida albicans Experimental catheters were also assessed for durability of antimicrobial activity for up 3 weeks. PCN catheters coated with M/R plus CHD completely inhibited biofilm formation for up to 3 weeks for all the organisms tested. The reduction in colonization compared to uncoated PCN catheters was significant for all Gram-positive, Gram-negative, and fungal organisms (P < 0.05). M/R-plus-CHD PCN catheters also produced significant reductions in biofilm colonization relative to M/R PCN catheters for Enterobacter spp., Escherichia coli, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, C. glabrata, and C. albicans (P < 0.05). M/R-plus-CHD PCN catheters proved to be highly efficacious in preventing biofilm colonization when exposed to multidrug-resistant pathogens common in PCN catheter-associated pyelonephritis. M/R-plus-CHD PCN catheters warrant evaluation in a clinical setting to assess their ability to prevent clinically relevant nephrostomy infections.
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Liu BX, Huang GL, Xie XH, Zhuang BW, Xie XY, Lu MD. Contrast-enhanced US-assisted Percutaneous Nephrostomy: A Technique to Increase Success Rate for Patients with Nondilated Renal Collecting System. Radiology 2017; 285:293-301. [PMID: 28467143 DOI: 10.1148/radiol.2017161604] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose To perform a single-center study of contrast material-enhanced ultrasonography (US)-assisted percutaneous nephrostomy (PCN) for patients with nondilated renal collecting system. Materials and Methods An international review board approved this retrospective study with waiver of informed consent for participation, and the study was approved by the Ethical Committee. From November 2011 to September 2015, 47 patients (mean age, 51.9 years ± 16.2 [standard deviation]; range, 18-80 years) with clinical necessity of urinary drainage, urinary diversion, or provision of access to the collecting system and with nondilated renal collecting system who underwent contrast-enhanced US-assisted PCN for 48 kidneys were included. US contrast agent was injected through the puncture needle and the drainage catheter to confirm successful PCN. The technical success rate and complications were evaluated. Relative frequencies with 95% confidence intervals (CIs) were calculated. Results The technical success rate was 100% (47 of 47, 95% CI: 93.8%, 100%) per patient and 100% (48 of 48, 95% CI: 94.0%, 100%) per kidney. For each kidney, the mean number of needle passes was 1.4 ± 0.5 (range, 1-3). The mean duration of the complete procedure was 18.9 minutes ± 4.8 (range, 8-30 minutes). The mean dose of contrast agent was 12.9 mL ± 3.2 (range, 8-25 mL). No major complications were observed. After a follow-up of 1-30 days (mean, 18.4 days ± 10.3), only four patients (four of 47, 8.5%, 95% CI: 2.37%, 20.4%) had minor complications, including one perirenal hematoma seen at US 9 days after the procedure and three patients with transient macroscopic hematuria that lasted 1-2 days. Conclusion Contrast-enhanced US-assisted PCN in patients with nondilated renal collecting system is valuable with high technical success rate. © RSNA, 2017.
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Affiliation(s)
- Bao X Liu
- From the Department of Medical Ultrasonics, Division of Interventional Ultrasound, Institute of Diagnostic and Interventional Ultrasound (B.X.L., G.L.H., X.H.X., B.W.Z., X.Y.X., M.D.L.), and Department of Liver Surgery (M.D.L.), the First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Road 2, Guangzhou 510080, China
| | - Guang L Huang
- From the Department of Medical Ultrasonics, Division of Interventional Ultrasound, Institute of Diagnostic and Interventional Ultrasound (B.X.L., G.L.H., X.H.X., B.W.Z., X.Y.X., M.D.L.), and Department of Liver Surgery (M.D.L.), the First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Road 2, Guangzhou 510080, China
| | - Xiao H Xie
- From the Department of Medical Ultrasonics, Division of Interventional Ultrasound, Institute of Diagnostic and Interventional Ultrasound (B.X.L., G.L.H., X.H.X., B.W.Z., X.Y.X., M.D.L.), and Department of Liver Surgery (M.D.L.), the First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Road 2, Guangzhou 510080, China
| | - Bo W Zhuang
- From the Department of Medical Ultrasonics, Division of Interventional Ultrasound, Institute of Diagnostic and Interventional Ultrasound (B.X.L., G.L.H., X.H.X., B.W.Z., X.Y.X., M.D.L.), and Department of Liver Surgery (M.D.L.), the First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Road 2, Guangzhou 510080, China
| | - Xiao Y Xie
- From the Department of Medical Ultrasonics, Division of Interventional Ultrasound, Institute of Diagnostic and Interventional Ultrasound (B.X.L., G.L.H., X.H.X., B.W.Z., X.Y.X., M.D.L.), and Department of Liver Surgery (M.D.L.), the First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Road 2, Guangzhou 510080, China
| | - Ming D Lu
- From the Department of Medical Ultrasonics, Division of Interventional Ultrasound, Institute of Diagnostic and Interventional Ultrasound (B.X.L., G.L.H., X.H.X., B.W.Z., X.Y.X., M.D.L.), and Department of Liver Surgery (M.D.L.), the First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Road 2, Guangzhou 510080, China
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McDevitt JL, Acosta-Torres S, Zhang N, Hu T, Odu A, Wang J, Xi Y, Lamus D, Miller DS, Pillai AK. Long-Term Percutaneous Nephrostomy Management of Malignant Urinary Obstruction: Estimation of Optimal Exchange Frequency and Estimation of the Financial Impact of Patient Compliance. J Vasc Interv Radiol 2017; 28:1036-1042.e8. [PMID: 28385361 DOI: 10.1016/j.jvir.2017.02.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/19/2017] [Accepted: 02/22/2017] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To estimate the least costly routine exchange frequency for percutaneous nephrostomies (PCNs) placed for malignant urinary obstruction, as measured by annual hospital charges, and to estimate the financial impact of patient compliance. MATERIALS AND METHODS Patients with PCNs placed for malignant urinary obstruction were studied from 2011 to 2013. Exchanges were classified as routine or due to 1 of 3 complication types: mechanical (tube dislodgment), obstruction, or infection. Representative cases were identified, and median representative charges were used as inputs for the model. Accelerated failure time and Markov chain Monte Carlo models were used to estimate distribution of exchange types and annual hospital charges under different routine exchange frequency and compliance scenarios. RESULTS Long-term PCN management was required in 57 patients, with 87 total exchange encounters. Median representative hospital charges for pyelonephritis and obstruction were 11.8 and 9.3 times greater, respectively, than a routine exchange. The projected proportion of routine exchanges increased and the projected proportion of infection-related exchanges decreased when moving from a 90-day exchange with 50% compliance to a 60-day exchange with 75% compliance, and this was associated with a projected reduction in annual charges. Projected cost reductions resulting from increased compliance were generally greater than reductions resulting from changes in exchange frequency. CONCLUSIONS This simulation model suggests that the optimal routine exchange interval for PCN exchange in patients with malignant urinary obstruction is approximately 60 days and that the degree of reduction in charges likely depends more on patient compliance than exact exchange interval.
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Affiliation(s)
- Joseph L McDevitt
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235.
| | - Stefany Acosta-Torres
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235
| | - Ning Zhang
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235
| | - Tianshen Hu
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235
| | - Ayobami Odu
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235
| | - Jijia Wang
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235
| | - Yin Xi
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235
| | - Daniel Lamus
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235
| | - David S Miller
- Division of Gynecologic Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235
| | - Anil K Pillai
- Division of Vascular and Interventional Radiology, Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Texas
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Rossi GM, Rocco R, Accorsi Buttini E, Marvisi C, Vaglio A. Idiopathic retroperitoneal fibrosis and its overlap with IgG4-related disease. Intern Emerg Med 2017; 12:287-299. [PMID: 28070877 DOI: 10.1007/s11739-016-1599-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 12/27/2016] [Indexed: 02/07/2023]
Abstract
Retroperitoneal fibrosis (RPF) is a rare disease characterised by fibrous tissue proliferation in the retroperitoneum, with encasement of the ureters and large vessels of the abdomen as the most destructive of potentially severe complications. It can either be idiopathic, or secondary to infections, malignancies, or the use of certain drugs. The idiopathic form accounts for approximately 75% of the cases, and is usually responsive to immunosuppressive therapy. In recent years, the emergence of a new clinical entity, IgG4-related disease (IgG4-RD), shed light on many fibro-inflammatory disorders once thought to be separate clinical entities, although frequently associated in the so-called multifocal fibrosclerosis. Among these, together with sclerosing pancreatitis and cholangitis, pseudotumour of the orbit, idiopathic mediastinal fibrosis and other conditions, is idiopathic retroperitoneal fibrosis (IRF). Both IRF and IgG4-RD can be associated with a wide variety of disorders, usually governed by immune-mediated (and particularly auto-immune) mechanisms. In our review, we discuss the clinical and therapeutic challenges IRF presents to the internist, as well as the meaning of its recent inclusion in the IgG4-RD spectrum from a clinical practice standpoint.
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Affiliation(s)
| | - Rossana Rocco
- Nephrology Unit, Parma University Hospital, Via Gramsci 14, 43126, Parma, Italy
| | | | - Chiara Marvisi
- Nephrology Unit, Parma University Hospital, Via Gramsci 14, 43126, Parma, Italy
| | - Augusto Vaglio
- Nephrology Unit, Parma University Hospital, Via Gramsci 14, 43126, Parma, Italy.
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40
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Stewart JK, Smith TP, Kim CY. Clinical implications of acute pelvicaliceal hematoma formation during percutaneous catheter nephrostomy insertion. Clin Imaging 2017; 43:180-183. [PMID: 28342336 DOI: 10.1016/j.clinimag.2017.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 02/21/2017] [Accepted: 02/24/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the clinical implications of acute pelvicaliceal hematoma formation during percutaneous catheter nephrostomy (PCN) insertion. METHODS Collecting system hematoma burden was retrospectively assessed for 694 PCN insertions in 502 patients. RESULTS Pelvicaliceal hematoma formation occurred in 146 kidneys (21%) in 136 patients. Clinically significant blood loss occurred in 3 patients with hematomas within one week compared to 4 patients without hematomas (p=0.39). Twenty-four patients with hematomas underwent catheter exchange within one week, compared to 55 patients without hematomas (p=0.49). CONCLUSION Pelvicaliceal hematoma formation after PCN insertion is not uncommon and is associated with very rare clinical sequelae.
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Affiliation(s)
- Jessica K Stewart
- Department of Radiology, Duke University Hospital, Box 3808 DUMC, Durham, NC 27710, United States.
| | - Tony P Smith
- Department of Radiology, Duke University Hospital, Box 3808 DUMC, Durham, NC 27710, United States.
| | - Charles Y Kim
- Department of Radiology, Duke University Hospital, Box 3808 DUMC, Durham, NC 27710, United States.
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41
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[Management of ureteral obstruction : Value of percutaneous nephrostomy and ureteral stents]. Urologe A 2016; 55:1497-1510. [PMID: 27787581 DOI: 10.1007/s00120-016-0253-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ureteral obstruction represents a heterogeneous disease pattern and is treated by ureteral stenting or percutaneous nephrostomy (PCN) depending on the necessity. The benefits of urinary diversion with ureteral stenting or PCN in malignant ureteral obstruction (MUO) for patient survival are only moderate. No differences have been found between ureteral stenting and PCN in MUO with regard to median patient survival and complication rates. In cases of MUO there is currently no evidence that urinary diversion improves the quality of life. Alternative concepts of ureteral stenting, such as tandem ureteral stents, metallic ureteral stents or metal mesh ureteral stents have not yet shown clear benefits. In benign ureteral obstruction, prospective randomized studies have demonstrated comparable quality of life after PCN or ureteral stenting. The method of choice for urinary diversion is influenced by the recommendations, personal experience of the clinician and the availability of the method.
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Cui XW, Ignee A, Maros T, Straub B, Wen JG, Dietrich CF. Feasibility and Usefulness of Intra-Cavitary Contrast-Enhanced Ultrasound in Percutaneous Nephrostomy. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2180-8. [PMID: 27262520 DOI: 10.1016/j.ultrasmedbio.2016.04.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 03/30/2016] [Accepted: 04/25/2016] [Indexed: 05/05/2023]
Abstract
The aim of this study was to evaluate the feasibility and utility of intra-cavitary contrast enhanced ultrasound (ICCEUS) in guiding percutaneous nephrostomy (PCN) and assessing complications. Forty-five ultrasound-guided PCNs were performed in 35 patients with hydronephrosis resulting from urinary tract obstruction. Ultrasound contrast agent (0.1 mL diluted in 20-30 mL saline) was injected through the puncture needle and the drainage tube to precisely locate the device and obstruction, with the fluoroscopy results considered the gold standard. ICCEUS was performed again the next day to assess complications. All 45 PCNs were successfully performed under the guidance of ultrasound. With ICCEUS, we could confirm the correct insertion of needle and catheter and locate the obstruction in all 35 patients, with fluoroscopic results as the gold standard. Catheter dislodgement was diagnosed by administration of ultrasound contrast agent in 5 patients. Hematoma (1 patient) and urine leakage (1 patient) were also observed. With the advantages of lack of exposure to radiation, performance in real time and bedside availability, ICCEUS has the potential to become a new modality to guide PCN and assess catheter-related complications.
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Affiliation(s)
- Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Medical Clinic 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Wuerzburg, Wuerzburg, Germany
| | - Andre Ignee
- Medical Clinic 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Wuerzburg, Wuerzburg, Germany
| | - Tiberius Maros
- Department of Urology, Caritas Krankenhaus, Bad Mergentheim, Academic Teaching Hospital of the University of Wuerzburg, Wuerzburg, Germany
| | - Bernd Straub
- Department of Urology, Caritas Krankenhaus, Bad Mergentheim, Academic Teaching Hospital of the University of Wuerzburg, Wuerzburg, Germany
| | - Jian-Guo Wen
- Department of Urology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Christoph F Dietrich
- Medical Clinic 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Wuerzburg, Wuerzburg, Germany; Sino-German Research Center of Ultrasound in Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Wallis J, De Rover WS, Ahmad R, Jobling JC. A Rare Case of Retained Foreign Material in the Pelvicalyceal System Precipitating Sepsis Following Percutaneous Nephrostomy. Cardiovasc Intervent Radiol 2016; 39:1218-21. [PMID: 27025217 DOI: 10.1007/s00270-016-1330-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/14/2016] [Indexed: 11/24/2022]
Affiliation(s)
- James Wallis
- School of Medicine and Surgery, University of Nottingham, Nottingham, NG7 2UH, UK.
| | | | - Rosemina Ahmad
- Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Hsu L, Li H, Pucheril D, Hansen M, Littleton R, Peabody J, Sammon J. Use of percutaneous nephrostomy and ureteral stenting in management of ureteral obstruction. World J Nephrol 2016; 5:172-181. [PMID: 26981442 PMCID: PMC4777789 DOI: 10.5527/wjn.v5.i2.172] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 12/25/2015] [Accepted: 01/22/2016] [Indexed: 02/06/2023] Open
Abstract
The management options for ureteral obstruction are diverse, including retrograde ureteral stent insertion or antegrade nephrostomy placement, with or without eventual antegrade stent insertion. There is currently no consensus on the ideal treatment or treatment pathway for ureteral obstruction owing, in part, to the varied etiologies of obstruction and diversity of institutional practices. Additionally, different clinicians such as internists, urologists, oncologists and radiologists are often involved in the care of patients with ureteral obstruction and may have differing opinions concerning the best management strategy. The purpose of this manuscript was to review available literature that compares percutaneous nephrostomy placement vs ureteral stenting in the management of ureteral obstruction from both benign and malignant etiologies.
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Pabon-Ramos WM, Dariushnia SR, Walker TG, Janne d’Othée B, Ganguli S, Midia M, Siddiqi N, Kalva SP, Nikolic B. Quality Improvement Guidelines for Percutaneous Nephrostomy. J Vasc Interv Radiol 2016; 27:410-4. [DOI: 10.1016/j.jvir.2015.11.045] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 11/17/2015] [Accepted: 11/17/2015] [Indexed: 11/16/2022] Open
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Alsyouf M, Arenas JL, Smith JC, Myklak K, Faaborg D, Jang M, Olgin G, Lehrman E, Baldwin DD. Direct Endoscopic Visualization Combined with Ultrasound Guided Access during Percutaneous Nephrolithotomy: A Feasibility Study and Comparison to a Conventional Cohort. J Urol 2016; 196:227-33. [PMID: 26905016 DOI: 10.1016/j.juro.2016.01.118] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE Percutaneous nephrolithotomy access may be technically challenging and result in significant radiation exposure. In an attempt to reduce percutaneous nephrolithotomy radiation exposure, a novel technique combining ultrasound and direct ureteroscopic visualization was developed and reviewed. MATERIALS AND METHODS Ureteroscopy without fluoroscopy was used to determine the optimal calyx for access, which was punctured with a Chiba needle under percutaneous ultrasound guidance. Next a wire was passed into the collecting system and ureteroscopically pulled into the ureter using a basket. Tract dilation and sheath and nephrostomy tube placement were performed under direct ureteroscopic visualization. Twenty consecutive patients undergoing this novel technique were reviewed and compared to 20 matched patients treated with conventional percutaneous nephrolithotomy. Mann-Whitney U and Pearson chi-square tests were used for comparisons with p <0.05 considered significant. RESULTS Using this novel technique mean fluoroscopy access time was 3.5 seconds (range 0 to 27.9) and mean total fluoroscopic time was 8.8 seconds (range 0 to 47.1). Mean operative time was 232 minutes (range 87 to 533), estimated blood loss was 111 ml, the stone-free rate was 65% and the complication rate was 25%. Compared to 20 matched conventional percutaneous nephrolithotomy cases, there was no difference in operative time (p=0.76), estimated blood loss (p=0.64), stone-free rate (p=0.50) or complications (p=1.00). However, the novel technique resulted in a significant reduction in fluoroscopy access time (3.5 vs 915.5 seconds, p <0.001) and total fluoroscopy time (8.8 vs 1,028.7 seconds, p <0.001). CONCLUSIONS This study demonstrates the feasibility of combined ultrasound and ureteroscopic assisted access for percutaneous nephrolithotomy. A greater than 99% reduction in fluoroscopy time was achieved using this technique.
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Affiliation(s)
- Muhannad Alsyouf
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Javier L Arenas
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Jason C Smith
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, California
| | - Kristene Myklak
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Daniel Faaborg
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Michael Jang
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Gaudencio Olgin
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Evan Lehrman
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, California
| | - D Duane Baldwin
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California.
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Le Guilchet T, Audenet F, Hurel S, Beaugerie A, Fontaine E, Terrier N, Timsit MO, Mejean A. [Conservative management of upper tract urinary fistulae using ureteral trans-vesico-parietal stent]. Prog Urol 2016; 26:152-8. [PMID: 26874826 DOI: 10.1016/j.purol.2016.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 12/20/2015] [Accepted: 01/09/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Ureteral stents and ureteral catheters externalized through the urethra are not ideal solutions to manage complicated upper urinary tract fistulae. We sought an effective method of drainage, minimally invasive, reproducible allowing a rapid patient's discharge. PATIENTS AND METHODS Between November 2013 and February 2015, an ureteral stent was exteriorized in trans-vesico-parietal by an endoscopic and percutaneous access in patients with complicated upper urinary tract fistulae. Monitoring of tolerance, complications and urinary fistula healing was performed. RESULTS Nine consecutive patients had an ureteral stent exteriorized in trans-vesico-parietal to manage complicated upper urinary tract fistulae. There was no failure in introducing the catheter, or postoperative complication. Catheters were left in place on average 36.1days (24-55). The patients were able to return home with the catheter in place in 77.8% of cases. The tolerance of the catheter was good. All fistulae were able to be treated conservatively at the end of the drainage period. CONCLUSION Trans-vesico-parietal ureteral catheters enable efficient and reproducible conservative treatment of upper tract urinary fistulae regardless of their cause. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- T Le Guilchet
- Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France.
| | - F Audenet
- Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France.
| | - S Hurel
- Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France.
| | - A Beaugerie
- Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France.
| | - E Fontaine
- Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France.
| | - N Terrier
- Service d'urologie, CHU Grenoble-Alpes, 38700 La Tronche, France.
| | - M O Timsit
- Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France.
| | - A Mejean
- Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France.
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Dinić L, Stanković J, Potić M, Skakić A, Mihajlović-Tošić M, Milić V, Vuković N, Kostić J, Đinđić N. PERCUTANEOUS NEPHROSTOMY AND DOUBLE PIGTAIL (JJ) URETERAL STENTS AS TEMPORARY METHODS IN SOLVING SUPRAVESICAL OBSTRUCTION CAUSED BY STONE. ACTA MEDICA MEDIANAE 2015. [DOI: 10.5633/amm.2015.0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Franke M, Winand S, Chang DH, Wille S, Maintz D, Bangard C. Urinary Tract Fistulas: Transrenal Reversible Ureteral Occlusion With Detachable Semicompliant Balloons. Urology 2015; 86:388-93. [PMID: 26169009 DOI: 10.1016/j.urology.2015.03.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 02/28/2015] [Accepted: 03/03/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate transrenal reversible ureteral occlusion with detachable balloons in patients with treatment-refractory urinary tract fistulas. METHODS From September 2009 to September 2013, reversible occlusion of 18 ureters (7 men, 3 women; 27-74 years) with treatment-refractory urinary leakage mostly because of tumor disease or iatrogenic surgical injury was performed. Nephrostomy was exchanged fluoroscopically into an 8F or 9F sheath, which was introduced into the ureter to the point of intended balloon inflation. The prepared semicompliant balloon on a special microcatheter was introduced into the sheath, inflated, and detached. A nephrostomy tube was placed in the pelvicalyceal system. After healing of the fistulas, urinary flow was restored by transureteral removal or computed tomography-guided percutaneous puncture of the balloons. RESULTS Hundred percent successful placement of the balloons and initial urinary fistula occlusion was achieved (18 of 18 ureters). One patient was lost during follow-up. Six of the remaining 9 patients needed reocclusion because of balloon dislocation or deflation (secondary technical success 83%; 5 of 6 ureters). A z-shaped ureter made reocclusion unsuccessful. Mean duration of ureteral occlusion was 74 days (5-250 days). After healing of the fistulas, intentional ureteral recanalization by percutaneous puncture or transureteral balloon removal was feasible. Anterograde urination was achieved in 5 of 9 patients (clinical success rate 55%). Four fistulas did not heal. Two patients died from their underlying disease. CONCLUSION Transrenal reversible off-label ureteral occlusion with semicompliant detachable balloons is feasible with a high technical success rate. Long-term ureteral occlusion can be achieved in nearly all patients with a moderate clinical success rate in heavily diseased patients.
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Affiliation(s)
- Mareike Franke
- Department of Radiology, University Hospital Cologne, Cologne, Germany
| | - Sabine Winand
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - De-Hua Chang
- Department of Radiology, University Hospital Cologne, Cologne, Germany
| | - Sebastian Wille
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - David Maintz
- Department of Radiology, University Hospital Cologne, Cologne, Germany
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50
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Esparaz AM, Pearl JA, Herts BR, LeBlanc J, Kapoor B. Iatrogenic urinary tract injuries: etiology, diagnosis, and management. Semin Intervent Radiol 2015; 32:195-208. [PMID: 26038626 PMCID: PMC4447880 DOI: 10.1055/s-0035-1549378] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Iatrogenic injury to the urinary tract, including the kidneys, ureters, bladder, and urethra, is a potential complication of surgical procedures performed in or around the retroperitoneal abdominal space or pelvis. While both diagnostic and interventional radiologists often play a central and decisive role in the identification and initial management of a variety of iatrogenic injuries, discussions of these injuries are often directed toward specialists such as urologists, obstetricians, gynecologists, and general surgeons whose procedures are most often implicated in iatrogenic urinary tract injuries. Interventional radiologic procedures can also be a source of an iatrogenic urinary tract injury. This review describes the clinical presentation, risk factors, imaging findings, and management of iatrogenic renal vascular and urinary tract injuries, as well as the radiologist's role in the diagnosis, treatment, and cause of these injuries.
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Affiliation(s)
- Anthony M. Esparaz
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Brian R. Herts
- Department of Abdominal Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Justin LeBlanc
- Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Baljendra Kapoor
- Department of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
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