Ultrasound-Guided Percutaneous Nephrostomy: How to Select Technique?
Journal Title: International Journal of Anatomy Radiology and Surgery - Year 2016, Vol 5, Issue 2
Abstract
ABSTRACT Introduction: Ultrasound guided percutaneous nephrostomy (PCN) is a safe and effective treatment option for obstructive uropathy. Several techniques have been described in documents. However, the recommendation of PCN technique has not been proposed. Aim: To determine the success and complication rates of ultrasound guided PCN. Meanwhile, we attempt to determine a baseline value in order to orient surgeon to select an optimal technique preoperatively. Materials and Methods: This was a retrospective study conducted at Department of Urology of the First People’s Hospital of Yueyang City, China. Total 150 PCNs under ultrasound guidance were analyzed. Two puncture techniques were used. In Seldinger technique (ST), ultrasound-guided puncture needle was inserted into the calyx; a drainage catheter was placed following the guidewire. In one-step technique (OT), the drainage catheter set was inserted directly into the collecting system under ultrasound guidance. Statistical Analysis: A statistical analysis was performed using the SPSS software package (versions 19.0). Results: Total 53 PCNs were performed using Seldinger technique, and 97 PCNs were performed using one-step technique. The ST group had higher technical success rate (100% vs 87.6%, p =0.008). The ST group also obtained higher success rate in <3 cm hydronephrosis subgroup (100% vs 44.4%, p<0.05). The success rate in ≥3cm subgroup was similar (100% vs 97.5%). The overall complication rate was 15.1% in ST group and 43.3% in OT group (p<0.05). The major complication rate was 1.9% vs. 13.4% (p<0.05). The minor complication rate was 13.3% vs 29.9% (p<0.05). Conclusion: Ultrasound-guided PCN is an effective and safe treatment method for obstructive uropathy. The Seldinger technique can effectively achieve success in all possible situations and is superior to the one-step technique when hydronephrosis is <3cm. One-step PCN is an effective and safe procedure in selected patients with hydronephrosis ≥3cm. We recommend 3cm of hydronephrosis should be an acceptable baseline for technique selection.
Authors and Affiliations
Huan Wang, Chuang Cao, Chang-hui Wang, Xing-qiu Fan, Jiang-ya Zhong
Keywords
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