Urinary tract obstruction: Ultrasound-guided intervention

Ultrasound ◽  
2021 ◽  
pp. 1742271X2110494
Author(s):  
Alexander Lory ◽  
Christopher Stubbs ◽  
Stephen Wolstenhulme ◽  
Atif Khan
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Obstruction ◽  
Imaging Modality ◽  
Surgical Techniques ◽  
Clinical Problem ◽  
Percutaneous Nephrostomy ◽  
Dynamic Imaging ◽  
Ultrasound Guided ◽  
Clinical Scenarios ◽  
Procedural Complications

Introduction Urinary tract obstruction (UTO) is a common clinical problem of which there are many potential causes. The aim of this feature article is to explore the role of ultrasound in diagnosing UTO, during guided interventional procedures and the potential procedural complications. Topic description and discussion: Ultrasound is an integral imaging modality throughout the management pathway of a patient with UTO and is often utilised as a first-line test in diagnosis and treatment. Percutaneous nephrostomy is an interventional technique, usually performed by radiologists or interventional sonographers, as either a short- or long-term management strategy. It can either be used in isolation or to gain access to the renal collecting system prior to more complex interventional or surgical techniques. Ultrasound-guided interventional techniques to relieve UTO can be employed in a number of clinical scenarios each with their own indications, contraindications and complications. Conclusion Ultrasound plays a unique role in the planning and active stages of intervention with the provision of dynamic imaging which is crucial for providing safe and effective patient management.

scholarly journals Ultrasound guided direct puncture percutaneous nephrostomy: a single tertiary centre observational study

2021 ◽  
Vol 8 (12) ◽  
pp. 3548
Author(s):  
Suresh Kumar Rulaniya ◽  
Samir Swain ◽  
Vishal Kumar Neniwal ◽  
Shweta Bhalothia ◽  
Kishor Tonge ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Obstruction ◽  
Low Cost ◽  
Percutaneous Nephrostomy ◽  
Upper Urinary Tract ◽  
Tube Placement ◽  
Ultrasound Guided ◽  
Direct Puncture ◽  
Upper Urinary Tract Obstruction ◽  
Grade Iii

Background: Percutaneous nephrostomy (PCN) is indicated to drain the upper urinary tract collecting system in cases of obstruction. Objective of our study is to evaluate the safety and efficacy of Ultrasound guided direct puncture PCN in our populations.Methods: This observational study was conducted from May 2020 to April 2021in department of urology and renal transplant. The total 65 patients with upper urinary tract obstruction requiring PCN were enrolled. All parameters were recorded and statistical analysis was performed using the Statistical package for the social sciences (SPSS 16.0) for windows.Results: In our study Ca Cervix with ureteric infiltration (35%) was the most common indication for PCN tube placement. Majority of patients (83%) had Grade IV and Grade III hydroneprosis. Single attempt for tube placement was sufficient most of the time in (86% cases). Direct Puncture PCN tube placement was successful in 62 (95.4%) cases. The mean duration of procedure was 12.4 minutes. Loin pain was the most common procedure related complication observed in 58 patients. There was no evidence of visceral injury, no need of blood transfusion in post procedural duration in our study.Conclusions: USG guided direct puncture PCN technique is simple, low cost, less time consuming, less chance of loss of tract and effective procedure for drainage of urine in case of upper urinary tract obstruction. We recommended this procedure in grade III and IV hydronephrosis and this procedure suitable for developing countries like India because of procedure related low cost.

scholarly journals Percutaneous Nephrostomy Tube-related Infections

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S349-S349 ◽  
Author(s):  
Hanine El Haddad ◽  
George Viola ◽  
Ying Jiang ◽  
Issam Raad ◽  
Kenneth V Rolston ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Median Time ◽  
Antimicrobial Therapy ◽  
Urinary Tract Obstruction ◽  
Recurrent Infection ◽  
Percutaneous Nephrostomy ◽  
Infectious Complications ◽  
High Rate ◽  
History Of

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.

The role of percutaneous nephrostomy in malignant urinary tract obstruction

1993 ◽  
Vol 47 (1) ◽  
pp. 32-35 ◽  
Author(s):  
A.F. Watkinson ◽  
R.P. A'hern ◽  
A. Jones ◽  
D.M. King ◽  
E.C. Moskovic
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Obstruction ◽  
Percutaneous Nephrostomy

scholarly journals 647 Management of Malignant Upper Urinary Tract Obstruction

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
F Lewis ◽  
N Neal
Keyword(s):  
Urinary Tract ◽  
Data Collection ◽  
Urinary Tract Obstruction ◽  
Percutaneous Nephrostomy ◽  
Upper Urinary Tract ◽  
University Hospital ◽  
National Guidelines ◽  
Emergency Presentation ◽  
Ureteric Stents ◽  
Upper Urinary Tract Obstruction

Abstract Background Malignant Upper Urinary Tract Obstruction (MUUTO) is a common emergency presentation. These are often complex patients and require multiple specialty input to make time-critical decisions. There are currently no national guidelines for the management of MUUTO, a review was conducted to assess the management and outcomes of MUUTO. Aim To agreed and review a pathway for patients with MUUTO in order to streamline patient care and to review the management. Method The pathway was devised by several consultants at Oxford University Hospital. Through retrospective data collection, the outcomes over six months were reviewed. Results Over the six-month period 49 interventions were performed for MUUTO; 44 Percutaneous Nephrostomy (PCN) and five cystoscopies with retrograde ureteric stents (RUS). Patients were admitted to urology in 45% of cases and oncology in 39%. The obstruction was located above the pelvis in 16 (33%) of the cases and within the pelvis in 25 (51%). The most common cancers causing obstruction were bladder cancer (41%), prostate (16%), and colorectal (14%). MDT advice was sought in 63% of cases. The mean time from diagnosis to the intervention was four days. Of the five retrograde inserted ureteric stents, four were unsuccessful and the patients proceeded to PCN. At the conclusion of data collection, 26 (53%) patients had died. Discussion The most striking findings were the high failure rate of RUS and the overall poor prognosis of MUUTO. As such this review suggests that more patients should proceed directly to PCN for decompression.

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