title: Inadvertent discontinuation of percutaneous nephrostomy catheters in adult native kidneys: incidence and percutaneous management.
abstract: OBJECTIVE
  To evaluate the incidence and consequences of complete inadvertent percutaneous nephrostomy catheter discontinuation in native kidneys of adults. In addition, this study evaluated the success rate of nephrostomy tract recannulation.
  
  
  METHODS
  Retrospective analysis was performed in adult patients who underwent percutaneous nephrostomy between January 2000 and December 2005. Patients' conditions were evaluated for complete inadvertent discontinuation of use of the nephrostomy catheters and success of subsequent recannulation procedures. Habitual discontinuation was defined by three catheter discontinuation episodes in one patient. Conditions of patients with inadvertent discontinuation were assessed for major complications before and after the recannulation, including the need for de novo nephrostomy to reestablish clinically needed access. The incidences of inadvertent discontinuation and primary assisted recannulation tract maintenance were calculated according to the Kaplan-Meier method. Successful versus unsuccessful recannulation procedures were compared for tract age, length of time the drain was out of the tract, and catheter diameter with use of the Mann-Whitney U test.
  
  
  RESULTS
  A total of 283 patients underwent 325 percutaneous nephrostomies. The inadvertent catheter discontinuation rates at 6, 12, 24, and 36 months were 26%, 36%, 53%, and 62%, respectively. For the same time intervals, the primary recannulation assisted tract maintenance rates were 94%, 86%, 77%, and 72%, respectively. Habitual discontinuation was seen in 3.2% of the total population and 19.1% of discontinuation cases. The technical success rates of all and first-time recannulations were 85% and 74%, respectively. Tract maturity was the only variable that was statistically significant between successful and unsuccessful recannulations (P < .0001). A total of 3.5% of patients required new nephrostomies.
  
  
  CONCLUSIONS
  Despite the high incidence of inadvertent discontinuation of nephrostomy catheters, the major complication rate was only 3.5%, indicating the efficacy of tract recannulation, especially in mature tracts.
authors.affiliation: Department of Imaging Sciences, Section of Vascular/Interventional Radiology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, New York 14642, USA. wspikes@yahoo.com
authors.forename: Wael E A
authors.initials: WE
authors.lastname: Saad
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Virdee
authors.forename: Mark G
authors.initials: MG
authors.lastname: Davies
authors.forename: Nikhil C
authors.initials: NC
authors.lastname: Patel
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Sahler
authors.forename: David E
authors.initials: DE
authors.lastname: Lee
authors.forename: Takashi
authors.initials: T
authors.lastname: Kitanosono
authors.forename: Talia
authors.initials: T
authors.lastname: Sasson
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Wilson
authors.forename: David L
authors.initials: DL
authors.lastname: Waldman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome