Diuretic agent and normal saline infusion technique for ultrasound-guided percutaneous nephrostomies in nondilated pelvicaliceal systems.
OBJECTIVE
Percutaneous nephrostomy (PCN) in a nondilated pelvicaliceal system is technically challenging. We describe an effective method to achieve transient dilatation of the pelvicaliceal system via induction of diuresis using infusion of a diuretic agent in normal saline, therefore allowing easier access to the pelvicaliceal system.


METHODS
Under real-time ultrasound guidance, the technique had been tested in 22 nephrostomies with nondilated system (a total of 20 patients with 2 patients having bilateral nephrostomies) during a 5-year period. Patients were given 40 mg of furosemide in 250 ml of normal saline solution intravenously by rapid infusion. As soon as maximum calyceal dilatation of more than 5 mm was observed, which is usually 15 min later after the end of rapid infusion, patients were positioned obliquely, and PCN procedure under ultrasound guidance was performed.


RESULTS
The procedure was successful in 19 of the nephrostomies in 17 patients with a success rate of 86.36 % per procedure and 85 % per patient in nondilated pelvicaliceal systems. No major nephrostomy-, drug-, or technique-related complications were encountered. The technique failed to work in three patients due to the presence of double J catheters and preexisting calyceal perforation which avoided transient dilation of the pelvicaliceal system with diuresis.


CONCLUSIONS
Diuretic infusion in saline is a feasible and effective method for PCN in nondilated pelvicaliceal systems.
Department of Radiology, School of Medicine, Ankara University, Ankara, Turkey. cemil.yagci@medicine.ankara.edu.tr
Cemil
C
Yagci
Evren
E
Ustuner
Ebru Dusunceli
ED
Atman
Sumer
S
Baltaci
Caglar
C
Uzun
Serdar
S
Akyar
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004232:Diuretics / Q000008:administration & dosage*; D005260:Female; D005665:Furosemide / Q000008:administration & dosage*; D006801:Humans; D007049:Iatrogenic Disease; D007670:Kidney Calices; D007674:Kidney Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D012965:Sodium Chloride / Q000008:administration & dosage*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D004232:Diuretics; D012965:Sodium Chloride; D005665:Furosemide