The role of percutaneous nephrostomy in malignant urinary tract obstruction

Abstract Background Percutaneous nephrostomy tubes (PCN) are indicated for relief of urinary tract obstruction. These devices are prone to mechanical and infectious complications. The infection rate at 90 days is ±20%. Our objective was to determine whether discordant antimicrobial coverage provided prior to PCN exchange was associated with a higher rate of recurrent infection compared with those who received concordant therapy. Methods We retrospectively reviewed 780 patients that had undergone initial PCN placement at our institution between July 2014 and February 2017. We only included patients that had developed a definite PCN infection, subsequent PCN exchange, with a minimum 30 day post-PCN exchange follow up. We defined PCN infection as the presence of a positive urine culture (≥104 cfu/mL) plus symptoms consistent with a urinary tract infection. Recurrence was defined as a new PCN infection with the isolation of the same organism to the initial episode. Antibiotics were defined as concordant if they had activity against all organisms’ isolated based on antimicrobial susceptibilities. Results A total of 47 patients met our inclusion criteria. The median age of patients was 59, with 49% being male. The most common underlying tumors were urothelial (45%), cervical (17%) and prostate cancer (15%). Clinical characteristics included ureteral stents (17%), diabetes (19%), history of GU surgery (38%), and active chemotherapy at the time of PCN insertion (70%). The median time to onset of infection was 42 days. Infections were polymicrobial in 50% of the cases. The most common organisms encountered were Pseudomonas spp. (36%), Enterococcus spp. (23%) and Escherichia coli (18%). The median length of follow up of PCN tubes after exchange was 55 days. There were 12 (26%) recurrences occurring at a median time of 27 days. The provision of discordant antibiotics preceding PCN exchange was significantly associated with recurrence of infection (66.7% vs. 12.8%; P < 0.002). Conclusion Discordant antimicrobial therapy provided during PCN exchange, in the setting of a PCN infection is associated with a higher rate of relapse. Therefore, to decrease the high rate for PCN reinfection, we propose that prior to PCN exchange secondary to infection, patients should be receiving concordant antimicrobial therapy. Disclosures All authors: No reported disclosures.

Download Full-text

The Role of Percutaneous Nephrostomy in the Management of Obstructing Candidiasis of the Urinary Tract in Infants

The Journal of Urology ◽

10.1016/s0022-5347(17)41597-7 ◽

1988 ◽

Vol 140 (2) ◽

pp. 338-341 ◽

Cited By ~ 34

Author(s):

Francis F. Bartone ◽

Richard S. Hurwitz ◽

Eduardo L. Rojas ◽

Evan Steinberg ◽

Ralph Franceschini

Keyword(s):

Urinary Tract ◽

Percutaneous Nephrostomy

Download Full-text

Upper urinary tract infection

10.1093/med/9780199592548.003.0177 ◽

2015 ◽

Author(s):

Mark Harber

Keyword(s):

Urinary Tract ◽

Acute Pyelonephritis ◽

Urinary Tract Obstruction ◽

Reflux Nephropathy ◽

Upper Urinary Tract ◽

Chronic Pyelonephritis ◽

Severe Illness ◽

Emphysematous Pyelonephritis ◽

Suppurative Infection

Pyelonephritis is a suppurative infection of the kidney most commonly due to bacterial infection that may be either acute or chronic. Acute pyelonephritis is usefully subdivided into uncomplicated and complicated. The term complicated pyelonephritis is associated with an abnormal urinary tract, obstruction, stones, immunocompromise, diabetes, pregnancy, or in practical terms any pyelonephritis resulting in severe illness. The distinction is important principally in terms of type, duration, and place of treatment.The clinical spectrum of acute pyelonephritis ranges from relatively mild illness to pyonephrosis and emphysematous pyelonephritis with a fulminant course and high mortality.The term chronic pyelonephritis has been used to describe kidneys damaged from multiple, recurrent, or partially treated episodes of infection, but for many of these examples ‘reflux nephropathy’ is a better description as the role of infection is not always clear. However chronic or very recurrent infections may be associated with diabetes, abnormal urinary tracts, and any cause of obstructed drainage. Chronic pyelonephritis is also an accurate description for the progressive ongoing destruction of the kidney that occurs in xanthogranulomatous pyelonephritis or malakoplakia.

Download Full-text

The Role of Antegrade Irrigation via Percutaneous Nephrostomy on Surgical Outcomes in Semirigid Ureteroscopy among Patients with Upper Ureteral Stones

BioMed Research International ◽

10.1155/2019/8657609 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Wonho Jung ◽

Hye Jin Byun ◽

Dong Sup Lee

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Operation Time ◽

Percutaneous Nephrostomy ◽

Stone Size ◽

Stone Free Rate ◽

Ureter Stones ◽

Free Rate

Objective. We aimed to investigate the role of antegrade irrigation via percutaneous nephrostomy on surgical outcomes in retrograde ureteroscopy in patients with upper ureter stones. Materials and Methods. In this retrospective study, we analyzed 134 patients who underwent retrograde semirigid ureteroscopy for upper ureter stones between August 2012 and December 2017. Patients were divided into two groups: retrograde irrigation group (conventional URS) and antegrade irrigation group (using percutaneous nephrostomy). Operation time, postoperative hospital stay, complications, and stone-free rate were measured for each patient after ureteroscopy. Results. The mean age in the retrograde irrigation and antegrade irrigation groups was 53.3 and 60.7 years, respectively (p=0.007). The operation time was 60.8 min vs. 43.0 min (p=0.002), and stone-free rate was 82.0 % vs. 95.5 % (p=0.033). Stone size, laterality, the proportion of male patients, and urinary tract infection prevalence were comparable between the groups. In the subgroup analysis of stone size >10 mm, the antegrade irrigation group had a shorter operation time and a higher stone-free rate. For stone size of 5–10 mm, operation time in the antegrade irrigation group was shorter and the stone-free rate between the two groups was comparable. Conclusion. Antegrade irrigation via percutaneous nephrostomy during ureteroscopy has a higher stone-free rate with a shorter operation time without an increased urinary tract infection risk. Therefore, if percutaneous nephrostomy is necessary before ureteroscopy, antegrade irrigation of external fluid via percutaneous nephrostomy is strongly recommended.

Download Full-text

508 Factors predicting septic shock after percutaneous nephrostomy tube placement for emergency drainage of upper urinary tract obstruction

European Urology Supplements ◽

10.1016/s1569-9056(14)60500-5 ◽

2014 ◽

Vol 13 (1) ◽

pp. e508

Author(s):

K. Nazmi ◽

A.M. Harraz ◽

M.H. Zahran ◽

H. Nabeeh ◽

H. Orban ◽

...

Keyword(s):

Septic Shock ◽

Urinary Tract ◽

Urinary Tract Obstruction ◽

Percutaneous Nephrostomy ◽

Upper Urinary Tract ◽

Tube Placement ◽

Nephrostomy Tube ◽

Upper Urinary Tract Obstruction

Download Full-text

P2-receptors of the urinary bladder as potential targets for novel drugs

Kazan medical journal ◽

10.17816/kmj2018-462 ◽

2018 ◽

Vol 99 (3) ◽

pp. 462-466

Author(s):

A U Ziganshin ◽

D V Bedova ◽

E A Zubkov ◽

M E Sitdykova

Keyword(s):

Urinary Tract ◽

Lower Urinary Tract ◽

Urinary Tract Obstruction ◽

P2 Receptors ◽

Evidence Evaluation ◽

Novel Drugs ◽

Lower Urinary Tract Obstruction ◽

Receptor Agonists And Antagonists ◽

Lower Urinary

Purinergic P2 receptors, the basic endogenous agonist of which is adenosine triphosphoric acid (ATP), are widely spread in the organs and tissues of human and animals including urogenitary system. Physiologically, in the peripheral nervous system the role of P2 receptors in most cases is not leading, they only complement or modulate the action of main neuromediators (acetylcholine, norepinephrine). But in pathology the role of P2 receptors significantly increases and often takes the lead in the pathogenesis of one or another disease. In particular, it was determined that purinergic component of contractile bladder response increases from 2-5% in normal state to 40% in some pathological processes (such as interstitial cystitis, neurogenic bladder, urinary obstruction). In the bladder of experimental animals different subtypes of P2 receptors were revealed, their functional role was established in normal conditions and models of pathological processes. Certain subtypes of P2 receptors were also detected in the human bladder, including in some urinary tract diseases. The level of ATP in patients’ urine was established to significantly increase in lower urinary tract obstruction that holds certain promise for the diagnosis of these diseases. Variety and large representation of P2 receptors in lower urinary tract make them attractive as potential targets for novel drugs. On this evidence, evaluation of effect of P2 receptor agonists and antagonists as well as medications affecting the metabolism of endogenous nucleotides and nucleosides, is one of promising direction for the search for new urological drugs.

Download Full-text