Visualization of the renal vein filled with contrast agent may indicate the renal vein injury during percutaneous nephrolithotomy: two case reports

Abstract Background Intravenous misplacement of a nephrostomy tube is a rare complication of percutaneous nephrolithotomy (PCNL) or percutaneous nephrostomy. The mechanism of misplacement of a nephrostomy tube into the vascular system is seldom investigated. One type of the possible mechanism is that the puncture needle penetrates a major intrarenal tributary of the renal vein and enters the collecting system. However, the guidewire is located outside the collecting system near the large branches of renal vein or perforates into the renal vein. The dilation is performed and causes a large torn injury. Subsequently, the nephrostomy tube is placed inside the vessel when radiological monitoring is not used. However, there is no imaging evidence and the scene of procedure is not demonstrated. This paper reports two cases of visualization of the renal vein filled with contrast agent during PCNL. The findings may be good evidence to support the step of renal vein injury in patients with intravenous nephrostomy tube misplacement. Case presentation We presented two cases with visualization of the renal vein filled with contrast agent during PCNL. In the process of injecting the contrast agent through the puncture needle, we could see the renal vein. Moreover, it was identified that the puncture needle tip was not on the optimal position. The position of puncture needle tip lay outside the collecting system, which was close to the calyceal infundibulum and branches of renal vein. Conclusions Visualization of the renal vein filled with contrast agent may be good evidence to verify the renal vein injury in patients with intravenous nephrostomy tube misplacement during PCNL or percutaneous nephrostomy. The suboptimal location of the puncture needle tip and visualization of the renal vein filled with contrast agent indicate the renal vein injury. One type of mechanism of intravenous nephrostomy tube misplacement is as following. Firstly, the guidewire stays outside the collecting system. Subsequently, dilatation directed by the guidewire results in the injury of the vein. Then, the nephrostomy tube migrates into the venous system due to prompt tube inserting and the direction of the sheath and/or the guidewire to the injured vein.

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Percutaneous silicon catheter insertion into the IVC, following percutaneous nephrostomy (PCN) exchange

Canadian Urological Association Journal ◽

10.5489/cuaj.1403 ◽

2013 ◽

Vol 7 (7-8) ◽

pp. 505 ◽

Cited By ~ 7

Author(s):

Ahmed F Kotb ◽

Ahmed Elabbady ◽

Khaled Mohamed ◽

Mohamed Adel Atta

Keyword(s):

Inferior Vena Cava ◽

Percutaneous Nephrolithotomy ◽

Renal Vein ◽

Inferior Vena ◽

Left Renal Vein ◽

Vena Cava ◽

Percutaneous Nephrostomy ◽

Fluoroscopic Guidance ◽

Nephrostomy Tube ◽

Tube Exchange

Percutaneous nephrostomy (PCN) has been widely used to drain an infected, obstructed kidney. Few major complications have been associated with it. Few publications have reported the misplacement of nephrostomy tube into the inferior vena cava (IVC), following percutaneous nephrolithotomy. We report a case of a misplaced silicon catheter, through the left renal vein, extending into the IVC, following nephrostomy tube exchange. Our case was safely managed, and we concluded that although PCN and nephrostomy tube exchange are relatively simple procedures, they should be done cautiously, by a well-trained urologist, and preferably under ultrasound or fluoroscopic guidance.

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Study of variations in the pelvicalyceal system of kidney and its clinical importance

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v8i3.8681 ◽

2013 ◽

Vol 8 (3) ◽

pp. 17-21 ◽

Cited By ~ 1

Author(s):

PR Wadekar ◽

SD Gangane

Keyword(s):

Percutaneous Nephrolithotomy ◽

Clinical Importance ◽

Percutaneous Nephrostomy ◽

Clinical Implications ◽

Clear Understanding ◽

Medical Sciences ◽

Pelvicalyceal System ◽

Collecting System

Objective The present study has been undertaken to study the variations in renal pelvicalyceal system, to compare them with previous studies and to find their clinical implications. Materials and Methods A total of 100 kidneys (from 50 cadavers) were included in this study. The following parameters were measured 1)Lower Infundibular length, 2)Infundibular Width – Lower Infundibular Width (LIW), Middle Infundibular Width (MIW), Upper Infundibular Width (UIW), 3)Number of minor calyces and 4)Number of major calyces. Results The obtained data showed that there were numerous variations not only in the numbers of calyces of kidneys but also in the infundibular length and width. Conclusion Developments in endourology, percutaneous nephrolithotomy and techniques for retrograde percutaneous nephrostomy have rekindled interest in the anatomy of the renal collecting system. To perform these procedures safely and efficiently it is essential to have a clear understanding of pelvicalyceal anatomy and its variations. Thus the in-depth knowledge of pelvicalyceal anatomy will be of immense value to the clinicians of related specialties. Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-3, 17-21 DOI: http://dx.doi.org/10.3126/jcmsn.v8i3.8681

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Renal Vein Injury During Percutaneous Nephrolithotomy Procedure

Journal of Endourology Case Reports ◽

10.1089/cren.2016.0089 ◽

2016 ◽

Vol 2 (1) ◽

pp. 148-151 ◽

Cited By ~ 1

Author(s):

Sarwar Noori Mahmood ◽

Hewa Mahmood Toffeq

Keyword(s):

Percutaneous Nephrolithotomy ◽

Renal Vein ◽

Vein Injury

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USING THE CORRECT SIZE OF AMPLATZ SHEATH DURING PERCUTANEOUS NEPHROLITHOTOMY – A NOVEL METHOD.

10.36106/gjra/3703532 ◽

2020 ◽

pp. 1-2

Author(s):

Rahul Goel

Keyword(s):

Percutaneous Nephrolithotomy ◽

Operating Time ◽

Nephrostomy Tube ◽

Renal Function Impairment ◽

Pelvic Wall ◽

Significant Difference ◽

Function Impairment ◽

Novel Method ◽

Collecting System ◽

Correct Size

Purpose- To choose appropriate size Amplatz sheath, during percutaneous nephrolithotomy (PCNL) based on retrograde nephrogram (RGP). Material and methods -Standard PCNL ,in prone position ,was performed in 20 patients. All patients had placement of Amplatz sheath based on retrograde nephrostogram study, all patients after surgery had nephrostomy tube for draining collecting system. The preoperative and postoperative renal parameters ,hemoglobin ,mean operating time and mean hospitalisation stay was measured. Results- There was no significant difference in the pre and postoperative hemoglobin and creatinine levels . Median operating time was 60.5 mins (45 to 98 mins).The median hospitalisation stay was 4.6 days( 3 to 7 days).There was no intraoperative pelvic wall or infundibular injury. Conclusion- Choosing correct size Amplatz sheath decreases the incidence of bleeding and renal function impairment.

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