Percutaneous interventions in pediatric patients

Purpose: The purpose of this study is to evaluate the effectiveness of image-guided percutaneous urinary interventions in infants and children having urinary tract obstruction.Material and Methods: Between November 2004 and June 2008, image-guided percutaneous interventions were performed to 31 kidneys of 25 infants and children (ages 15 days-11 years) having urinary tract obstructions. Initial puncture was performed with a 22-gauge fine-needle under sonographic guidance. The remaining of the procedure was completed under fluoroscopic guidance using the co-axial micropuncture technique. Urinary drainage was supplied by percutaneous nephrostomy in 17 pts, percutaneous nephroureterostomy in 6 pts and percutaneous nephroureterocystostomy in 8 pts. Percutaneous ureteral balloon dilation was performed in one patient and percutaneous double J stent was placed in one. In order to prevent catheter dislodgement on the following days, drainage catheters were placed as distally as possible in the urinary tract.Results: Urinary obstruction is secondary to ureteropelvic junction obstruction in 9 patients and 10 kidneys, ureterovesical junction obstruction in 11 patients and 13 kidneys. Both ureteropelvic junction and ureterovesical junction obstruction in one patient. Proksimal obstruction in right kidney is secondary to renal tuberculosis in one patient, distal obstruction in left kidney is secondary to pelvic tumor in one patient and bilateral distal obstruction is secondary to pelvic tumor in one patient. All procedures were succesfully achieved in all patients. In 8 patients (32%) self limited haematuri occured as a minor complication to the procedure. Distal ureteral perforation occured in one patient during the procedure but it was removed with catheterisation. Urinary drainage was effectively provided in all patients at follow-up.Conclusion: Image-guided percutaneous drainage procedures can be performed safely and effectively in pediatric patients having urinary tract obstruction. Differently from adult patients, drainage catheter should be placed as distally as possible in order to prevent catheter dislodgement.