輸尿管鏡協助置放無法重置之滑脫腎臟造廔管
張舜凱、周詠欽
嘉義基督教醫院 外科部 泌尿科
Ureteroscope-aid reinsertion of dislodged pigtail nephrostomy tube cannot be inserted manually
Shun-Kai Chang, Yeong-Chin Jou
Department of Urology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC.
Purpose: Percutaneous nephrostomy (PCN) is widely used in hydronephrosis by ureteral obstruction caused with variety clinical situation. If the tube becomes dislodged, tube exchange becomes more difficult or impossible sometimes. Neither nephrostomy tractogram by radiologist to pass over guidewire or renal puncture for new PCN creation is subsequently needed. We present several cases with ureteroscope aid that is useful in replacing dislodged nephrostomy tubes.
Materials and Methods: A total of 9 dislodged pigtail nephrostomy tube cases received ureteroscope-aid reinsertion between 2013 and 2016. Manual reinsertion of guidewire and pigtail have been tried before ureteroscopy-aid procedure in all of the 9 patients but failed. Ureteroscope was inserted through the old PCN opening and the missed access nephrostomy tract was re-identified under the inspection of ureteroscpe. All procedures were under local anesthesia. The clinical features of these 9 patients were evaluated by retrospective chart review.
Results: Seven cases received the procedure within 24 hours after pigtail nephrostomy tube dislodged. The others are 2 days and 8 days, respectively. The interval after PCN creation is from 2 weeks to 10 months. Eight cases were successfully reinserted pigtail nephrostomy tube by ureteroscope aid. The operation time is from 15 minutes to 30 minutes. Only one case failed and received renal puncture for new PCN creation. There were no severe related complications except for one case with post-operative fever 1 day after procedure and was admitted for antibiotic treatment without any sequel.
Conclusion: Reinsertion of dislodged pigtail nephrostomy tube by the aid of ureteroscope is a relatively simple, safe and effective procedure which can be performed under local anesthesia. It may decrease the necessity of new PCN tract creation and reduce the related complications.