Complications of percutaneous nephrostomy in the treatment of malignant ureteral obstructions: single-centre review.
OBJECTIVE
The purpose of this study was to evaluate the incidence and type of complications connected with percutaneous nephrostomy (PCN) deployment by comparing two different techniques.


METHODS
In the last 3 years, 299 procedures of nephrostomy were performed on 201 patients (93 women, 108 men; mean age 65.7 years, range 32-102 years) at our Institute; all patients were affected by malignancy. In 44 cases (14.72%), patients presented grade IV hydronephrosis and in 255 cases (85.28%) grade II-III hydronephrosis. In 68 patients (23.07%), the procedure was carried out under emergency conditions because of the rapid worsening of renal function. All procedures were carried out in the angiography room, with the patient lying in a prone or prone-oblique position, under ultrasound and fluoroscopic guidance. Access to the pyelocalyceal system (intermediate or lower calices) was performed by using a Seldinger technique in 255/299 cases, or a one-step technique (OST) in 44 procedures when grade 4 hydronephrosis was present. Statistical analysis of results was performed using bilateral tests on proportions as well as chi2 test of independence for contingency tables.


RESULTS
We observed no major complications. All in all, the rate of minor complications was 3.01% (9/299 cases): 8/255 (3.13%) cases with the Seldinger technique; 1/44 (2.27%) with OST. We observed 43/299 (14.4%) dislodgements: 32/255 (10.70%) with the Seldinger technique and 11/44 (3,68%) with OST. In 4/299 (1.33%), rupture of the catheter occurred, and in 2/299 (0.67%), kinking occurred (in all cases with OST). From the statistical analysis, we conclude that the examination technique modifies the percentage of complications; in particular, it significantly (p<0.05) influences complications connected with the catheter but not minor complications. In addition, the system of fixing does not affect the percentage of dislodgements.


CONCLUSIONS
PCN is a method with a high percentage of technical success with low rate of complications thanks to combined use of sonographic and fluoroscopic guidance for the procedure. The OST technique is indicated for a highly remarkable hydronephrosis and in cases where the catheter is only placed for a short period. The Seldinger technique is carried out in patients with grades II and III hydronephrosis and if the disease is predicted to have a long duration.
Carrafiello
G
G
Radiologia Vascolare e Interventistica--Cattedra di Radiologia, Università degli Studi dell'Insubria, Viale Borri 57, I-21100, Varese, Italy. gcarraf@tin.it
Laganà
D
D
Mangini
M
M
Lumia
D
D
Recaldini
C
C
Bacuzzi
A
A
Marconi
A
A
Mira
A
A
Cuffari
S
S
Fugazzola
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D015641:Radiography, Interventional; D018084:Ultrasonography, Interventional; D014516:Ureteral Neoplasms / Q000150:complications* / Q000473:pathology; D014517:Ureteral Obstruction / Q000209:etiology / Q000473:pathology / Q000601:surgery*