Role of percutaneous urinary diversion in malignant and benign obstructive uropathy.

OBJECTIVES We evaluated the feasibility and effectiveness of percutaneous urinary diversion in patients with obstructive uropathy. PATIENTS AND METHODS A total of 206 percutaneous nephrostomies (PCNs) (right-sided in 54, left in 56, and bilateral in 48) were performed in 102 male and 57 female patients 18 to 94 years old. In 125 patients, malignancy was the underlying cause of the obstruction and in 30, benign disease. In four patients, the cause remained unknown. In most patients (N = 154), the access was guided with both ultrasound and fluoroscopy. RESULTS Percutaneous nephrostomy was successful in 158 patients (99%). Antegrade ureteral stenting was attempted in 48 patients with a success rate of 81%. Fifteen days postprocedure, the mean urea and creatinine concentrations had declined from 160.8 mg/mL to 63 mg/mL and from 6.9 mg/dL to 2.2 mg/dL, respectively. In 66% of the patients, renal function returned to normal. In 28%, it improved with no need for hemodialysis, while in 6%, there was no improvement. Advanced age and prostate cancer were negative predictive factors for the improvement of renal function, whereas the BUN and creatinine concentrations before the procedure and performance of unilateral v bilateral nephrostomies were not. We did not have severe complications. Three patients received transfusions, and in one patient, a urinoma was drained percutaneously. Patients with malignancy had a median survival of 227 days. CONCLUSION Percutaneous urinary diversion under radiologic guidance is a safe and effective procedure for patients with obstructive uropathy.

[1]  C. Roehrborn,et al.  Optimal method of urgent decompression of the collecting system for obstruction and infection due to ureteral calculi. , 1998, The Journal of urology.

[2]  M. Hicks,et al.  A review of radiologically guided percutaneous nephrostomies in 303 patients. , 1997, Journal of vascular and interventional radiology : JVIR.

[3]  E. Friedman,et al.  Obstructive uropathy in gynecologic malignancy. Detrimental effect of intraureteral stent placement and value of percutaneous nephrostomy. , 1995, ASAIO journal.

[4]  M. Hoffman,et al.  Percutaneous nephrostomy and ureteral stenting in gynecologic malignancies , 1992, Obstetrics and gynecology.

[5]  M. Stoller,et al.  Palliative percutaneous and endoscopic urinary diversion for malignant ureteral obstruction. , 1991, Urology.

[6]  J. Hoffman,et al.  Is percutaneous nephrostomy for hydronephrosis appropriate in patients with advanced cancer? , 1988, American journal of surgery.

[7]  G. Janetschek,et al.  Urinary diversion in gynecologic malignancies. , 1988, European urology.

[8]  M. Jewett,et al.  Nonoperative urinary diversion for malignant ureteral obstruction , 1987, Cancer.

[9]  B. Goldberg,et al.  Percutaneous nephrostomy: comparison of sonographic and fluoroscopic guidance. , 1981, AJR. American journal of roentgenology.

[10]  J. Newhouse,et al.  Percutaneous catheterization of the kidney and perinephric space: Trocar technique , 1981, Urologic radiology.

[11]  H. Grabstald,et al.  The rationale of urinary diversion in cancer patients. , 1979, The Journal of urology.