Emergency percutaneous nephrostomy: technical success based on level of operator experience.

PURPOSE: The outcomes of emergency percutaneous nephrostomy procedures performed by operators with different levels of experience were analyzed. PATIENTS AND METHODS: A prospective study of 160 patients undergoing 169 emergency percutaneous nephrostomies was conducted. Three categories of operator experience were compared based on the number of percutaneous nephrostomies performed each year (level 1 = more than 20, level 2 = 10-20, or level 3 = less than 10). RESULTS: The level 1 operators (mean fluoroscopy time, 2 minutes; mean procedure time, 25 minutes) achieved success in 141 of 142 cases (99%) and failed in one case (1%), which was repeated successfully the next day. The level 2 operators (mean fluoroscopy time, 6 minutes; mean procedure time, 35 minutes) achieved initial success in all of 15 cases (100%), but three cases (20%) were repeated the next day because of catheter migration or malposition. Level 3 operators (mean fluoroscopy time, 10 minutes; mean procedure time, 42 minutes) were successful in 10 of 12 cases (83%), but in four cases (33%) the procedure had to be repeated. CONCLUSION: The experience of the operators played little role in the initial success rate of the procedure after they had performed 10 or more per year. However, the level of experience did influence the number of procedures that needed to be repeated, the prevalence of minor complications, and the mean fluoroscopy and procedure time.

Emergency percutaneous nephrostomy: results and complications.

PURPOSE: Percutaneous nephrostomy is a well-established standardized procedure in the management of patients with various urologic problems. The goal of this study was to evaluate the effectiveness and safety of percutaneous nephrostomy in an emergency setting. PATIENTS AND METHODS: Emergency percutaneous nephrostomy was performed in 160 patients with ages ranging from 2 to 89 years (mean, 52 years). Access to the kidney was planned and achieved with C-arm fluoroscopic guidance. RESULTS: The initial technical success rate was 98%. Overall complication rate was 34%; 6% were major and 28% were minor. Major procedure-related complications, including sepsis, occurred in 6% of patients. Hematuria requiring transfusion was noted in 2.4% of patients. Minor complications included catheter displacement or malposition (4.8%), pelvic perforation (4.3%), paralytic ileus (2.4%), pneumonia/atelectasis (1.8%), and pleural effusion (1.2%). High-risk patients included those with diabetes, hypertension, and obesity. No deaths or significant morbidity resulted from any complication. CONCLUSIONS: Emergency percutaneous nephrostomy under fluoroscopic guidance is a simple, safe, and effective procedure and should be offered in all suitably equipped radiology departments.