ABSTRACT
Objective:
To investigate the
methods and
complications of ultrasound-guided
percutaneous nephrostomy (
PCN) for treat-ing
cancer-related
hydronephrosis.
Methods:
From June 2003 to December 2015, 289
patients (342
kidneys) with
cancer-related hy-dronephrosis were treated by ultrasound-guided
PCN in Fujian Provincial
Hospital. Among the 97 cases of
renal insufficiency, 4 pa-tients were treated with
hemodialysis before
PCN. Except for the anterior mid calyx of nine
kidneys in nine
patients, the posterior mid or lower pole calyx of all other
kidneys was punctured with ultrasound guidance. With the one-step
PCN technique, 8F pigtail nephros-tomy tubes were placed into six
kidneys in six
patients;with the Seldinger
PCN technique, 14F balloon and Malecot
catheters were placed into 25
kidneys in 25
patients and 311
kidneys in 258
patients, respectively.
Results:
No severe
bleeding and
injury in the intes-tine,
liver,
spleen,
pleura, or
lung occurred. Two pigtail tubes were blocked one week after
PCN. Seven balloon
catheters failed to drain well because of the tip and balloon of the
catheters located in the proximal part of the dilated
ureters. Four balloons slipped out of the collection system of the
kidney because of the auto-deflation of three balloons and one case of meager renal parenchyma failing to hold the balloon after a severe
hydronephrosis was emptied. All, except 1, Malecot
catheter drained well, and 8/9 PCNs through anteri-or mid calyx were successful.
Serum creatinine levels were significantly decreased in all the 97
patients with
renal insufficiency, of which 81 cases returned to normal, and no one needed persistent
hemodialysis.
Conclusion:
Ultrasound-guided
PCN is safe and effec-tive for treating
cancer-related
hydronephrosis. For appropriately selected
patients, puncturing the anterior mid calyx may be an op-tion without additional
complications. One-step pigtail
nephrostomy tubes are recommended for
patients with poor systemic condi-tions. For
patients with long
life expectancy or suspected complicated urinary
infection, large sized Malecot
catheters should be consid-ered.