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Percutaneous nephrostomy insertion: outcome data from a prospective multi-operator study at a UK training centre.
T M Wah1, M J Weston, H C Irving
1Department of Radiology, St James's University Hospital, Leeds, UK.
Clinical Radiology
|March 24, 2004
Summary
This study evaluated percutaneous nephrostomies (PCNs) in a UK training center. Both Seldinger and one-stab techniques showed high success rates and were within established complication targets.
Area of Science:
- Urology
- Interventional Radiology
- Nephrology
Background:
- Percutaneous nephrostomy (PCN) is a common procedure for urinary diversion.
- Assessing success and complication rates is crucial for quality improvement and training.
Purpose of the Study:
- To evaluate the outcomes of percutaneous nephrostomies (PCNs) performed at a UK training center.
- To compare the success and complication rates of different PCN techniques used by varying operator experience levels.
Main Methods:
- A retrospective analysis of 276 PCNs performed in 190 patients during 2002.
- Two techniques were used: Seldinger (ultrasound-guided puncture, wire insertion, track dilatation) and ultrasound-guided one-stab (Bonanno catheter).
- Technique selection depended on collecting system anatomy and procedural timing (out of hours).
Main Results:
- The Seldinger technique had a primary technical success rate of 98% (218 procedures), while the one-stab technique achieved 93% (62 procedures).
- Major complication rates were 4.1% (Seldinger) vs. 3.2% (one-stab); minor complication rates were 5% vs. 13%.
- Tube-related complications were higher with the Seldinger technique (29.5% vs. 17.7%). 30-day mortality was 4.3%, unrelated to the procedure.
Conclusions:
- Both PCN techniques demonstrated success rates within proposed international targets.
- The ultrasound-guided one-stab technique is a safe and effective option for selected cases with significant pelvicalyceal dilatation.
- These findings establish a benchmark for PCN outcome targets in the UK.