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DOI: 10.1055/s-0039-3401842
Emergent Percutaneous Nephrostomy for Pyonephrosis: A Primer for the On-Call Interventional Radiologist
Publikationsverlauf
Publikationsdatum:
04. März 2020 (online)
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Abstract
Pyonephrosis is gross accumulation of pus within an obstructed renal collecting system that, if left untreated, can lead to potentially fatal septic shock. Treatment requires urgent decompression coupled with systemic antibiotics. Percutaneous nephrostomy (PCN) placement, first described in 1976 for the treatment of pyonephrosis, is now widely utilized for emergent decompression in these patients. When performed by an experienced interventional radiologist, PCN is a safe procedure with technical success rates of over 96 to 99%. This article will address the clinical presentation of pyonephrosis, and will discuss the indications, technique, complications, and outcomes of emergent PCN placement. Additionally, the expanded indications for PCN placement in nonemergent scenarios will also be described.
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References
- 1 Barbaric ZL, Davis RS, Frank IN, Linke CA, Lipchik EO, Cockett AT. Percutaneous nephropyelostomy in the management of acute pyohydronephrosis. Radiology 1976; 118 (03) 567-573
- 2 Pabon-Ramos WM, Dariushnia SR, Walker TG. , et al; Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for percutaneous nephrostomy. J Vasc Interv Radiol 2016; 27 (03) 410-414
- 3 Farrell TA, Hicks ME. A review of radiologically guided percutaneous nephrostomies in 303 patients. J Vasc Interv Radiol 1997; 8 (05) 769-774
- 4 Goodwin WE, Casey WC, Woolf W. Percutaneous trocar (needle) nephrostomy in hydronephrosis. J Am Med Assoc 1955; 157 (11) 891-894
- 5 Lee WJ, Patel U, Patel S, Pillari GP. Emergency percutaneous nephrostomy: results and complications. J Vasc Interv Radiol 1994; 5 (01) 135-139
- 6 Lewis S, Patel U. Major complications after percutaneous nephrostomy-lessons from a department audit. Clin Radiol 2004; 59 (02) 171-179
- 7 Ng CK, Yip SK, Sim LS. , et al. Outcome of percutaneous nephrostomy for the management of pyonephrosis. Asian J Surg 2002; 25 (03) 215-219
- 8 Yoder IC, Lindfors KK, Pfister RC. Diagnosis and treatment of pyonephrosis. Radiol Clin North Am 1984; 22 (02) 407-414
- 9 Bitsori M, Raissaki M, Maraki S, Galanakis E. Acute focal bacterial nephritis, pyonephrosis and renal abscess in children. Pediatr Nephrol 2015; 30 (11) 1987-1993
- 10 Uehling DT, Hahnfeld LE, Scanlan KA. Urinary tract abnormalities in children with acute focal bacterial nephritis. BJU Int 2000; 85 (07) 885-888
- 11 Radecka E, Magnusson A. Complications associated with percutaneous nephrostomies. A retrospective study. Acta Radiol 2004; 45 (02) 184-188
- 12 Pearle MS, Pierce HL, Miller GL. , et al. Optimal method of urgent decompression of the collecting system for obstruction and infection due to ureteral calculi. J Urol 1998; 160 (04) 1260-1264
- 13 Chehab MA, Thakor AS, Tulin-Silver S. , et al. Adult and pediatric antibiotic prophylaxis during vascular and IR procedures: a Society of Interventional Radiology Practice Parameter Update endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology. J Vasc Interv Radiol 2018; 29 (11) 1483-1501.e2
- 14 Cochran ST, Barbaric ZL, Lee JJ, Kashfian P. Percutaneous nephrostomy tube placement: an outpatient procedure?. Radiology 1991; 179 (03) 843-847
- 15 Patel IJ, Davidson JC, Nikolic B. , et al; Standards of Practice Committee, with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Endorsement. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol 2012; 23 (06) 727-736
- 16 Montvilas P, Solvig J, Johansen TE. Single-centre review of radiologically guided percutaneous nephrostomy using “mixed” technique: success and complication rates. Eur J Radiol 2011; 80 (02) 553-558
- 17 Uppot RN. Emergent nephrostomy tube placement for acute urinary obstruction. Tech Vasc Interv Radiol 2009; 12 (02) 154-161
- 18 Thornton RH, Covey AM. Urinary drainage procedures in interventional radiology. Tech Vasc Interv Radiol 2016; 19 (03) 170-181
- 19 Krohmer SJ, Pillai AK, Guevara CJ, Bones BL, Dickey KW. Image-guided nephrostomy interventions: how to recognize, avoid, or get out of trouble. Tech Vasc Interv Radiol 2018; 21 (04) 261-266
- 20 Hopper KD, Yakes WF. The posterior intercostal approach for percutaneous renal procedures: risk of puncturing the lung, spleen, and liver as determined by CT. AJR Am J Roentgenol 1990; 154 (01) 115-117
- 21 Clark TW, Abraham RJ, Flemming BK. Is routine micropuncture access necessary for percutaneous nephrostomy? A randomized trial. Can Assoc Radiol J 2002; 53 (02) 87-91
- 22 Dyer RB, Regan JD, Kavanagh PV, Khatod EG, Chen MY, Zagoria RJ. Percutaneous nephrostomy with extensions of the technique: step by step. Radiographics 2002; 22 (03) 503-525
- 23 Ajib KM, Matta IF, Zgheib JT, Jabbour ME. Non-angled intercostal percutaneous access under full expiration: safety is not an issue anymore. J Endourol 2017; 31 (08) 736-741
- 24 Picus D, Weyman PJ, Clayman RV, McClennan BL. Intercostal-space nephrostomy for percutaneous stone removal. AJR Am J Roentgenol 1986; 147 (02) 393-397
- 25 Munver R, Delvecchio FC, Newman GE, Preminger GM. Critical analysis of supracostal access for percutaneous renal surgery. J Urol 2001; 166 (04) 1242-1246
- 26 Flukes S, Hayne D, Kuan M, Wallace M, McMillan K, Rukin NJ. Retrograde ureteric stent insertion in the management of infected obstructed kidneys. BJU Int 2015; 115 (Suppl. 05) 31-34
- 27 Pandey S, Sharma D, Sankhwar S. , et al. Are there any predictive risk factors for failure of ureteric stent in patients with obstructive urolithiasis with sepsis?. Investig Clin Urol 2018; 59 (06) 371-375
- 28 Zagoria RJ, Dyer RB. Do's and don't's of percutaneous nephrostomy. Acad Radiol 1999; 6 (06) 370-377
- 29 Borofsky MS, Walter D, Shah O, Goldfarb DS, Mues AC, Makarov DV. Surgical decompression is associated with decreased mortality in patients with sepsis and ureteral calculi. J Urol 2013; 189 (03) 946-951
- 30 Lang EK, Price ET. Redefinitions of indications for percutaneous nephrostomy. Radiology 1983; 147 (02) 419-426
- 31 Rana AM, Zaidi Z, El-Khalid S. Single-center review of fluoroscopy-guided percutaneous nephrostomy performed by urologic surgeons. J Endourol 2007; 21 (07) 688-691
- 32 Khalilzadeh O, Baerlocher MO, Shyn PB. , et al. Proposal of a new adverse event classification by the Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol 2017; 28 (10) 1432-1437.e3
- 33 Li AC, Regalado SP. Emergent percutaneous nephrostomy for the diagnosis and management of pyonephrosis. Semin Intervent Radiol 2012; 29 (03) 218-225
- 34 Tuttle DN, Yeh BM, Meng MV, Breiman RS, Stoller ML, Coakley FV. Risk of injury to adjacent organs with lower-pole fluoroscopically guided percutaneous nephrostomy: evaluation with prone, supine, and multiplanar reformatted CT. J Vasc Interv Radiol 2005; 16 (11) 1489-1492
- 35 Prassopoulos P, Gourtsoyiannis N, Cavouras D, Pantelidis N. A study of the variation of colonic positioning in the pararenal space as shown by computed tomography. Eur J Radiol 1990; 10 (01) 44-47
- 36 Miller GL, Summa J. Transcolonic placement of a percutaneous nephrostomy tube: recognition and treatment. J Vasc Interv Radiol 1997; 8 (03) 401-403