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Percutaneous Nephrostomies: Planning for an Optimal Access, Complications, Follow-up and Outcome
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Percutaneous nephrostomy (PCN) is a well-established intervention performed to divert urine from the collecting system in ureteric obstruction or as a prelude to interventional procedures such as stent placement or percutaneous nephrolithotripsy (PCNL). The aim of this thesis is to enhance planning for an optimal insertion of PCN, investigate complications, long-term management, follow-up and outcome in patients with PCN treatment and to increase accuracy in CT-guided punctures.

To enhance planning for an optimal insertion of PCN prior to PCNL, biomodels from CT data were performed. Eight patients with complex urinary calculi were selected. Multislice CT of the kidney was performed and the CT data were transformed into a biomodel. The biomodels visualised unique structures before surgery, which aided the planning of endourological procedures.

PCNL is an essential procedure for treating complex urinary calculi. A subcostal approach is preferred to avoid laceration to the lung and pleura. However, a supracostal approach is often preferable, as it gives a better passage to the renal pelvis. The nature and frequency of complications after supra- versus subcostal punctures were studied in 85 patients treated with PCNL. In 63 patients, a subcostal track was established. In 22, a supracostal puncture was chosen. The main difference in preoperative complications was the higher number of patients in the supracostal group complaining of respiratory correlated pain (32%). In the subcostal group, this was (5%).

401 patients were reviewed retrospectively regarding underlying disease, subsequent management and complications of PCN treatment. The number of major complications was 4%. Minor complications were recorded in 38%, urinary tract infection being the most common. 151/401patients suffered from malignancy. 84/151 of the malignant patients died with the catheter. The median survival time of the patients with malignancies was 255 days and the median catheterisation time was 62 days.

In order to increase accuracy when performing CT guided punctures, a new puncture guide was evaluated. In 15/17 patients the puncture was successful on the first attempt. The benefits of the puncture guide were the artefact from the needle guide pointing at the target indicating the puncture path and the needle support enhancing an accurate puncture.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2005. , p. 50
Keywords [en]
Radiology, Percutaneous nephrostomy, Percutaneious nephrolithotripsy, Complications, Puncture technique, CT guidance
Keywords [sv]
Radiologisk forskning
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
URN: urn:nbn:se:uu:diva-4788ISBN: 91-506-1796-6 (print)OAI: oai:DiVA.org:uu-4788DiVA, id: diva2:165774
Public defence
2005-03-18, Grönwallsalen, Uppsala University Hospital, Entrance No. 70, Uppsala, 09:15
Opponent
Supervisors
Available from: 2005-02-25 Created: 2005-02-25Bibliographically approved
List of papers
1. Complications associated with percutaneous nephrolithotripsy: supra- versus subcostal access: A retrospective study
Open this publication in new window or tab >>Complications associated with percutaneous nephrolithotripsy: supra- versus subcostal access: A retrospective study
2003 In: Acta Radiologica, ISSN 0284-1851, Vol. 44, no 4, p. 447-451Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-92621 (URN)
Available from: 2005-02-25 Created: 2005-02-25Bibliographically approved
2. Complications associated with percutaneous nephrostomies: A retrospective study
Open this publication in new window or tab >>Complications associated with percutaneous nephrostomies: A retrospective study
2004 In: Acta Radiologica, ISSN 0284-1851, Vol. 45, no 2, p. 184-188Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-92622 (URN)
Available from: 2005-02-25 Created: 2005-02-25Bibliographically approved
3. CT-Guided punctures using a new guidance device
Open this publication in new window or tab >>CT-Guided punctures using a new guidance device
In: Acta Radiologica, ISSN 0284-1851Article in journal (Refereed) Submitted
Identifiers
urn:nbn:se:uu:diva-92623 (URN)
Available from: 2005-02-25 Created: 2005-02-25Bibliographically approved
4. Pelvo-calyceal biomodelling as an aid to achieving optimal access in percutaneous nephrolithotomy
Open this publication in new window or tab >>Pelvo-calyceal biomodelling as an aid to achieving optimal access in percutaneous nephrolithotomy
Show others...
In: British Journal of UrologyArticle in journal (Refereed) Submitted
Identifiers
urn:nbn:se:uu:diva-92624 (URN)
Available from: 2005-02-25 Created: 2005-02-25Bibliographically approved
5. Survival time and period of catheterisation in patients treated with percutaneous nephrostomy for urinary obstruction due to malignancy
Open this publication in new window or tab >>Survival time and period of catheterisation in patients treated with percutaneous nephrostomy for urinary obstruction due to malignancy
2006 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 47, no 3, p. 328-331Article in journal (Refereed) Published
Abstract [en]

PURPOSE:

To assess patient mortality and survival time, period of catheterization, and indications for percutaneous nephrostomy (PCN) withdrawal in patients treated with PCN for urinary obstruction due to malignancy.

MATERIAL AND METHODS:

A retrospective analysis of 151 patients treated with 257 PCNs in a 5-year period was performed. Data on survival time, duration of catheterization, and clinical end-points for PCN treatment were collected.

RESULTS:

The median survival time of the patients was 255 days, while median catheterization time was 62 days. The majority of patients (84) died with the catheter. Indications for PCN withdrawal were surgery, stent treatment, catheter displacement, and response to medical treatment.

CONCLUSION:

The majority of patients with malignancy treated with PCN have advanced disease and short life expectancy. Factors such as diagnosis, prognosis, economy, and the patient's preference influence the choice of urinary diversion method. However, PCN should be considered in patients with malignancy on grounds of safety and low cost.

Keywords
Aged, Aged; 80 and over, Colorectal Neoplasms/complications, Female, Follow-Up Studies, Humans, Male, Middle Aged, Nephrostomy; Percutaneous, Retrospective Studies, Survival Rate, Time Factors, Ureteral Obstruction/etiology/*mortality/*surgery, Urinary Catheterization, Urogenital Neoplasms/complications
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-92625 (URN)10.1080/02841850500492092 (DOI)16613316 (PubMedID)
Available from: 2005-02-25 Created: 2005-02-25 Last updated: 2017-12-14Bibliographically approved

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