Percutaneous nephrostomy in the management of malignant ureteral obstruction: an alternative using central venous catheter and “zero irradiation”

Volume 1 - Issue 2

Juan C Astigueta^1,2,3*, Juan E Silva¹, Benjamin A Leiva¹, Miracles A Abad Licham³ and Reynaldo D Kantt⁴

Received: March 26, 2018;   Published: April 03, 2018

DOI: 10.32474/OAJOM.2018.01.000110

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Abstract

Introduction and Objective: Percutaneous Nephrostomy (NP) is a procedure that involves the placement of a drainage catheter in the renal pelvis by puncture through the skin guided by an imaging method. The objective of the work is to present our experience in PN with ultrasound guidance (zero irradiation) in patients with ureteral obstruction secondary to oncological pathologies, showing the step-by-step technique and the usefulness of the 7 French central venous catheter set (CVC-7F).

Material and methods: Prospective work carried out in two institutions between 2010 and 2016. The eligibility criteria to perform percutaneous nephrostomy with ultrasound guidance (NPGE) with CVC-7F were: adult patients with oncological pathology with a dilated collecting system (moderate-severe hydronephrosis) and distance between the skin and renal pelvis less than the length of the needle. Patients with non-correctable coagulation disorder and terminal disease with ECOG 3-4 were excluded. Data on indications, technique and complications were collected.

Results: 212 NPGE were performed with CVC-7F in 189 patients with hydronephrosis secondary to oncological pathologies, 180 female and 09 male; 174 cases with diagnoses of cervical cancer, 04 of prostate, 03 of rectum, 06 of bladder, 01 of uterine sarcoma and 01 pesudotumor (genitourinary tuberculosis). The patients presented moderate-severe hydronephrosis. The main symptoms were oligo-anuria, hyperazoemia and low back pain. The average age was 59 years (range 18-83). It was performed with local anesthesia after coagulation study and consent signature. The average time of the procedure was 11 minutes and no case presented greater complication.

Conclusions: The NPGE using the set of CVC-7F, is an effective alternative of low cost, safe, reproducible and without exposure to radiation, in patients who present moderate-severe hydronephrosis and with distance between skin and dilated renal pelvis, less than the length of the needle used. We consider that the adequate choice of the patient has allowed us to have good results without major complications.

Keywords: Percutaneous ephrostomy; Ultrasound; Obstructive uropathy; Cancer

Abbrevations: NP: Percutaneous Nephrostomy; NPGE: Percutaneous Nephrostomy with Ultrasound Guidance; CVC-7F: 7 French Central Venous Catheter; ECOG: Eastern Cooperative Oncology Group

Abstract| Introduction| Material and Methods| Results| Discussion| Conclusion| Contributions of the authors| References|