Percutaneous nephrostomy in non-dilated kidneys for iatrogenic ureteral injuries

Amaç: Perkütan nefrostomi, iyatrojenik üreter yaralanmalarının tedavisinde çok önemli bir seçenektir. Ancak bu hastalarda pelvikaliseal sistem dilate olmadığı için işlem zordur. Bu çalışmanın amacı dilate olmayan böbreklerde perkütan nefrostomi deneyimimizi paylaşmaktır. Gereç ve Yöntemler: İatrojenik üreter yaralanması olan 14 hasta (10 kadın ve 4 erkek) çalışmaya dahil edildi. Bu hastaların 10'u jinekolojik ve 4’ü ürolojik cerrahi sırasında iyatrojenik üreter yaralanması geçirdi. Ultrasonografi ve floroskopi rehberliğinde toplam 17 nefrostomi işlemi (3 bilateral) gerçekleştirildi. İşlem öncesi pelvikaliseal sistemde dilatasyonu sağlamak için intravenöz diüretik infüzyonu uygulandı. İşlemde böbreğe giriş için daha ince iğne ve introduser sistem kullanıldı. Bulgular: Diüretik infüzyon sonrası 10 işlemde renal pelviste 5 mm'den fazla dilatasyon sağlandı ve tüm bu işlemlerde nefrostomi kateteri yerleştirilmesi başarılı oldu. Diğer 7 işlemde 5 mm'den az dilatasyon sağlandı ve bu işlemlerin 4'ünde (%23,5) nefrostomi kateteri yerleştirilmesi başarısız oldu. Teknik başarı oranı %76,5 idi ve majör komplikasyon gözlenmedi. Minör komplikasyon olarak 17 işlemin 5'inde (%29,4) minimal perirenal hematom meydana geldi. Sonuç: Perkütan nefrostomi, dilate pelvikaliksiyel sistemler için yüksek başarı ve düşük komplikasyon oranları ile basit bir işlemdir. Öte yandan dilate olmayan böbreklerde işlem genellikle zordur ve komplikasyonların sıklığı ve işlemsel başarısızlık oranı yüksektir.

Anahtar Kelimeler:

Perkütan nefrostomi, dilate olmayan pelvikalisiyel sistem, üreter yaralanması

Percutaneous nephrostomy in non-dilated kidneys for iatrogenic ureteral injuries

Aim: Percutaneous nephrostomy is a crucial option in the treatment of iatrogenic ureter injuries. However, in these patients, the procedure is difficult since the pelvicalyceal system is not dilated. The aim of this study is to share our percutaneous nephrostomy experience in non-dilated kidneys. Materials and Methods: Fourteen patients (10 females and 4 males) with iatrogenic ureter injury were included in the study. As the cause of the injury, ten of these patients had gynecological surgery where four had urological surgery. A total of 17 nephrostomy procedures (3 bilateral) were performed under ultrasonography and fluoroscopy guidance. In order to provide dilatation in pelvicalyceal system before the procedure, intravenous diuretic infusion was applied. In the procedure, a thinner needle and introducer system was used for the kidney access. Results: After diuretic infusion, dilatation more than 5 mm in renal pelvis was achieved in 10 procedures and nephrostomy catheter placement was successful in all of these procedures. Less than 5 mm dilatation was achieved in other 7 procedures and nephrostomy catheter placement was unsuccessful in 4 of these procedures (23.5%). Technical success rate was 76.5% and no major complications were observed. Minimal perirenal hematoma occurred in 5 of 17 procedures (29.4%) as a minor complication. Conclusion: Percutaneous nephrostomy is a simple procedure with high success and low complication rates for dilated pelvicalyceal systems. On the other hand, in non-dilated kidneys, the procedure is usually difficult, and the frequency of complications and the rate of procedural failure is high.

Keywords:

Percutaneous nephrostomy, non-dilated pelvicalyceal system, ureteral injury,

PDF

___

1. Goodwin WE, Casey WC, Woolf W. Percutaneous trocar (needle) nephrostomy in hydronephrosis. J Am Med Assoc 1955;157:891-4.
2. Lee WJ, Patel U, Patel S, Pillari GP. Emergency percutaneous nephrostomy: results and complications. J Vasc Interv Radiol 1994;5:135-9.
3. Lewis S, Patel U. Major complications after percutaneous nephrostomy-lessons from a department audit. Clin Radiol 2004;59(2):171-9.
4. Degirmentepe RB, Alkan I, Otunctemur A. Böbrek ve Üreter Yaralanmaları. Güncel Üroloji. 2.baskı; 2018. p.139-53.
5. Watson RA, Esposito M, Richter F, Irwin Jr RJ, Lang EK. Percutaneous nephrostomy as adjunct management in advanced upper urinary tract infection. Urology 1999;54:234-9.
6. Pabon-Ramos WM, Dariushnia SR, Walker TG, et al; Society of Interventional Radiology Standards of Practice Committee. Quality Improvement Guidelines for Percutaneous Nephrostomy. J Vasc Interv Radiol 2016;27(3):410-4.
7. Patel U, Hussain FF. Percutaneous nephrostomy of nondilated renal collecting systems with fluoroscopic guidance: technique and results. Radiology 2004;233(1):226-33.
8. Stable DP. Percutaneous nephrostomy. Technique, indications and results. Urol Clin North Am 1982;9:15-29.
9. Lawson RK, Murphy JB, Taylor AJ, Jacobs SC. Retrograde method for percutaneous access to kidney. Urology 1983;22:580-2.
10. Zegal HG, Pollack HM, Banner MP, et al: Percutaneous nephrostomy. Comparison of sonographic and fluoroscopic guidance. AJR Am J Roentgenol 1981;137:925-7.
11. Gupta S, Gulati M, Suri S. Ultrasound-guided percutaneous nephrostomy in non-dilated pelvicaliceal system. J Clin Ultrasound 1998;26(3):177-9.
12. Ramchandani P, Cardella JF, Grassi CJ, et al. Quality improvement guidelines for per¬cutaneous nephrostomy. J Vasc Interv Radiol 2001;12:1247-51.