Introduction and Objectives
The basic aim of this study was to analyze the results from the percutaneous nephrostomies (PNS) inserted in our clinic and to assess their role in treating urinary tract obstruction and acute infection.
Material and Methods
We performed a retrospective chart review of 119 patients (65 males and 54 females, mean age 59 years) treated by percutaneous nephrostomy (PNS) for upper urinary tract obstruction in our Urology department for a period of 2 years. A total number of 147 PNS were inserted: 45% in the right kidney, 31% in the left one and bilateral in 24% of the cases. Pelvic malignancies caused the obstruction in 57% of the patients. We analyzed the indications for PNS, the surgical technique, the laboratory findings upon admission, and the effectiveness of the percutaneous drainage. A parallel analysis of 226 patients (95 males and 131 females, mean age 57 years) treated in the Nephrology unit for pyelonephritis over the same period was also done. Patients were divided according to complicated or non complicated urinary tract infections (UTI). Bacterial strains, laboratory findings and causes for complicated UTI were analyzed.
Successful renal drainage was obtained in 100% of the cases. In 92% the nephrostomic tube was inserted only under ultrasound guidance. Only 12% of the patients required perioperative dialysis, while in the rest the kidney function was restored after the insertion of PNS. Pyonephrosis was found in 22% of the cases – in all these patients the procedure helped in healing the infection. The comparative analysis of the nephrological patients with UTI showed that PNS could effectively treat obstruction and acute UTI, but it could also be a source (in around 15%) of complicated UTI. The main cause of complicated UTI remained kidney stone disease.
PNS is a safe and reliable procedure in everyday urological practice with low early complication rates. It can be performed under ultrasound guidance with a high rate of success and it is highly effective in restoring the kidney function, as well as in treating complicated UTI. As a late complication, the PNS itself can become a source for contamination with rare polyresistant bacterial strains, thus being a cause for complicated UTI.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.