Percutaneous needle nephrostomy

Novel Coaxial Technique of Percutaneous Nephrostomy in Young Children: A Feasibility Study

AIMS

The conventional Seldinger and trocar techniques of percutaneous nephrostomy (PCN) have inherent limitations in infants and younger children. We studied the role of a novel coaxial technique of PCN in children under the age of 5 years in comparison to the conventional techniques.

MATERIALS AND METHODS

This was a single-center feasibility trial based on 24 consecutive patients (n = 24 kidneys) under the age of 5 years, conducted over 12 months, substratified into Group I (n = 10): PCN with conventional Seldinger (n = 2) and trocar (n = 8) techniques and Group II (n = 14): PCN with proposed coaxial technique. In the proposed technique, catheter was inserted through the bore of a 14-G needle. The observation parameters included successful placement of PCN into the renal pelvis with free drainage of urine, number of needle punctures, duration of procedure, need for fluoroscopy, and procedural complications.

RESULTS

Proposed technique was successful in all cases with single-needle puncture, while conventional techniques were successful in 8/10 (80%) cases with multiple needle punctures required in 3/10 (33.3%) cases (P = 0.163 and 0.059, respectively). Proposed technique was associated with lower median procedure time (6 min vs. 10.5 min; P < 0.001) and lower incidence of fluoroscopy use (0/14, 0% vs. 5/10, 50%; P = 0.006) than the conventional techniques. No complications were seen with either technique.

CONCLUSION

The proposed coaxial technique is a feasible alternative to the conventional techniques of PCN in young children. It reduces the procedure time and the need for fluoroscopy in these patients.

Health Education Intervention for Patients Undergoing Placement of Percutaneous Nephrostomy Tube: A Randomized Controlled Trial

PURPOSE

The purpose of this study was to compare the economic impact (cost) of percutaneous nephrostomy (PCN) tube care in patients following an educational intervention to no intervention.

DESIGN

A randomized controlled trial.

SUBJECTS AND SETTING

The sample comprised 178 patients recruited between May 2017 and April 2019. The study setting was the Marqués de Valdecilla University Hospital located in Cantabria on the northern coast of Spain. Data were collected in the hospital's radiology department.

METHODS

Participants were randomly allocated to 2 groups: an intervention group received an educational intervention that specifically addressed living with a PCN tube and a control group that received standard instruction. The intervention group received the educational intervention twice, before placement of the nephrostomy and at first tube change (6 weeks later). The main outcome variable was economic impact of the PCN, operationally defined as unscheduled or urgent visits and health care costs related to PCN tube placement.

RESULTS

When compared to control group subjects, participants who received the educational intervention had fewer urgent (unscheduled) visits (1.9 vs 4.0; P = .004) and lower direct and indirect health care costs reflecting a savings of €5277 (approximately US $6257).

CONCLUSIONS

The health education intervention reduced costs associated with these additional visits when compared to patients receiving standard postprocedural education.

Percutaneous nephrostomy as adjunct management in advanced upper urinary tract infection

OBJECTIVES

To determine by retrospective review of 315 percutaneous nephrostomies, performed for pyonephrosis, whether this intervention has major clinical advantages.

METHODS

From 1977 to 1996, under the direct supervision of the senior author of this report (E.K.L.), at seven hospital sites, 315 patients (181 males, 134 females; 17 to 88 years of age) were treated with percutaneous nephrostomy and antibiotic therapy for infected hydronephrosis.

RESULTS

Additional or disparate pathogens were identified in 116 (36.8%) of 315 patients, leading to a clinically significant change in, or addition of, antibiotics and/or antifungal agents in 84 (73%) of 116. Most notably, we often found a clinically important disparity between the results of cultures obtained from the nephrostomy and those obtained from bladder-urine specimens.

CONCLUSIONS

This retrospective review confirms previously reported advantages of percutaneous upper urinary tract drainage as a potentially life-saving adjunct in the treatment of pyonephrosis. Several case studies highlight the advantage of this maneuver in difficult cases involving obstruction due to extensive fungus or debris. In particular, our review focuses attention on the clinically important insight that urine cultures from percutaneous nephrostomy drainage often identify pathogens that differ from those detected in concurrent bladder cultures.

Pyonephrosis: a critical review of 131 cases

One hundred and thirty-one patients operated on for pyonephrosis within a 4-year period are reviewed. Male to female ratio was 1:2 and urolithiasis was the most common aetiological factor (70.2%). Primary nephrectomy proved to be a very satisfactory mode of treatment. Preliminary nephrostomy no longer appears necessary other than in exceptional circumstances. In a selected group of patients with pyonephrosis following acute obstruction of the kidney by a stone, successful management was achieved by prompt relief of the obstruction.

Percutaneous nephrostomy--technique

Percutaneous nephrostomy is increasingly used for temporary relief of upper urinary tract obstruction. The technique described involves the use of angiographic catheters and guides, and will provide drainage for several weeks or months. The patient is placed in the prone oblique position after intravenous contrast to opacify the kidneys. The oblique position ensures that a needle advanced vertically toward the kidney will pass along a posterior oblique line, entering the outer aspect of the kidney away from the hilum and directing guide wires and catheters toward the ureter. A fine needle is passed vertically into the kidney to determine its depth and to provide a pyelogram. A needle-cannula is then directed at the collecting system along a similar line until urine comes back. An angiographic J-guide is introduced and the needle exchanged for a series of vessel dilators, to dilate the track through the tissues. Finally, a catheter is passed over the guide wire into the collecting system, secured to the patient and attached to the drainage bag. Other maneuvers such as ureteral stenting can be added to this technique. The complications and technical difficulties are discussed.

Percutaneous catheterization of the kidney and perinephric space: trocar technique

Percutaneous nephrostomy can be accomplished by using a trocar-cannula assembly without resorting to serial dilations of the tube tract or utilizing stiff catheters. After puncture the trocar is removed and a catheter inserted through the cannula; then the cannula is removed. A large number of these procedures have been performed and have been found to be simple and quite safe. The method is able to provide nephrostomy drainage in virtually any case of ureteral obstruction or leak, and can be used to drain perinephric fluid collections as well. Antegrade pyelography precedes trocar puncture; puncture is most easily guided by fluoroscopy. The technique is described in detail; indications, applications, complications, and contraindications are outlined.

Percutaneous nephrostomy: techniques, indications, and results

During the past six years at our institution, percutaneous nephrostomy has been utilized for temporary diversion of the upper urinary tract in 33 patients and 42 individual kidneys. Two techniques are described, one of which has been developed recently by one of us (A.R.G.). Indications and results, including complications, are discussed. In our experience this procedure has been found to be safe and highly useful in the management of selected patients who have unilateral or bilateral urinary tract obstruction from a variety of reasons.

Renal puncture in infancy

Renal puncture was used in the diagnosis of five infants with suspected cystic disease of the kidney. This technique is simple and it may provide information that may otherwise be difficult to obtain.