Assesment of success and complication rates of ultrason guided percutaneous nephrostomy for obstructive uropathy in benign and malign cases

Objective Aim of this study is to asses the efficiency, usability, reliability and clinical benefits of application of ultrasound guided percutaneous nephrostomy under local anesthesia by urologists on patients of all ages, presented with urinary obstruction caused by benign and/or malign pathologies. Matherial and Method Files of the patients who were subject to an ultrasound guided percutaneous nephrostomy under local anesthesia by urologists at various clinics (urology, medical oncology, nephrology) of Dicle University School of Medicine between September 2011 and October 2017 were scanned retrospectively by using hospital's own data management system HBYS. Patient's clinical, laboratory, clinical examination, follow-up and demographic data and percutaneous nephrostomy indications were documented. Ultrasound guided percutaneous nephrostomy was accepted as successful under these conditions: Spontaneous urine drainage after catheter application and nephrostomy catheter being confirmed within pelvicalixial structures on antegrade pyelography, which is only performed when a definitive conclusion was not reached. Complications of nephrostomy were documented from patient files and reported according to modified Clavien classification system. Findings Ultrasound guided percutaneous nephrostomy (PCN) was performed on 668 kidney units of 351 male, 203 female, a total of 554 patients aged between 14 days and 90 years. Most common PCN indications were urinary system stones (168 patients), urinary system malignities (168 patients), malignities of origins other than urinary system (55 patients, infective situations such as pyonephrosis/renal abscess (49 patients), UPBO and/or urethra tightness (49 patients). Success rate of application was 93%. Nephrostomy culture was obtained from 41.7% of patients, of these cultures 42.17% had meaningful bacterial growth, and 78.35% of these bacterial growth positive cultures had antibiotic resistance. Total complication rate was 17.1%. most common complication was transient macroscopic hematuria with no blood transfusion required. Nephrostomy complications were assessed according to modified Clavien classification. According to this classification 39 patients (7%) with grade 1 complications, 5 patients (%0,9) with grade 2 complications. 37 patients (6.7%) with grade 3a complications, 1 patients (0.2%) with grade 4a complications, 10 patients (1.8%) with grade 4b complications, and 3 patients (0.5%) with grade 5 complications were identified. Result Percutaneous nephrostomy under local anesthesia performed by urologists on patients with urinary obstructions caused by either benign or malign pathologies is highly successful, safe, cheap, efficient and sometimes can be life saving. Modified Clavien classification allows nephrostomy complications to be reported under one consensus. Key Words Percutaneous nephrostomy, Benign and Malign ethiology, Obstructive Uropathy, Local anesthesia, modified Clavien Classification System, Ultrasound Guided.