戴德森醫療財團法人嘉義基督教醫院 外科部 泌尿科
Mid-term and long-term complications of percutaneous nephrostomy
Chu-Min Chou, Yeong-Chin Jou, Cheng-Huang Shen, Chang-Te Lin, Ming-Chin Cheng Department of Urology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
Purpose: To evaluate the mid-term and long-term complications for patients receiving percutaneous nephrostomy at our hospital.
Material and Method: We retrospective reviewed medical record of patients receiving regular percutaneous nephrostomy revision at our hospital for more than 3 times between January 2017 to October 2019. Catheter related complications were evaluated by catheter related emergency room visits and unexpected catheter revisions. Complications were classified by the Clavien-Dindo Classification system. Average interval of catheter revision, whether the etiology of hydronephrosis was malignancy or not were also reviewed.
Results: A total of 28 patients were identified, with 12 males and 16 females. The mean age was 72.43 Of the 28 patients, 15 patients (53.6%) received percutaneous nephrostomy due to hydronephrosis secondary to malignancy. Total number of catheter revision were 414. The mean interval for catheter change was 47.07 days. Total number of catheter related emergency room visits were 40, and average interval of emergency room visit were 425.55 days. Total number of unexpected catheter revision were 34 times, and the ratio of total catheter revision to unexpected catheter revision were 12.18 times. Most common catheter related complications were obstruction or dysfunction followed by catheter dislodge. Total counts of complication events were 64 (Grade IIIa: 39, grade II: 2, grade I: 23), and most of grade IIIa complications could be managed by catheter revision under local anesthesia without need of further admission. Most of the grade I complications were managed by manual irrigation and no further medication was needed.
Conclusions: Percutaneous nephrostomy remained an effective and safe procedure in treating hydronephrosis. Most of the catheter related complications, including unexpected revision, could be managed without need of admission. Further study aims for comparing percutaneous nephrostomy with ureteral stent could provide more information when choosing treatment for hydronephrosis in the future.