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
Multidetector Computed Tomographic Evaluation of Proptosis
ABSTRACT Introduction: Forward protrusion of the eyeball with respect to the orbit is known as proptosis. There are various causes of proptosis, among which lesions within the orbit are the commonest while para-orbital l...
Giant Thymoma from Ectopic Thymic Tissue in Children: A Case Report and Review of Literature
ABSTRACT Thymoma is a rare tumor in paediatric age group. It is a locally invasive slow growing tumor with occasional occurrence of extra thoracic metastasis. The report of incidence of thymoma from ectopic thymic tissue...
Role of Color Doppler for Assessment of Malignancy in Solid Breast Masses: A Prospective Study
Introduction: Mammography and ultrasound are the commonly used modalities for radiological evaluation of breast masses and assessment of aggressive features that point towards malignancy. Color Doppler provides vital inf...
The Reliability and Reproducibility of Patellotrochlear Index as a Measure of Patellar Instability in Indian Population
Introduction: The knee joint is one of the most used and abused joint of the body and hence knee discomfort and pain is one of the primary complaint of patients presenting to the orthopaedic out-patient department. There...
Intradiverticular Bladder Carcinoma-A Rare Case Report
The most common intradiverticular malignancy is urothelial cancer. Bladder diverticula can be caused either by congenital or acquired defects which results in out pouching of the bladder wall. Intradiverticular urothelia...