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[Diagnostic and therapeutic significance of percutaneous nephrostomy in children]
Insights
Percutaneous nephrostomy effectively relieves upper urinary tract obstruction in children, offering immediate therapeutic and diagnostic benefits for various causes like congenital stenosis and stones. This minimally invasive approach facilitates recovery and prepares patients for definitive surgery.
Area of Science:
- Pediatric Urology
- Interventional Radiology
- Nephrology
Context:
- Obstruction of the upper urinary tract in pediatric patients presents significant clinical challenges.
- Traditional surgical interventions for urinary obstruction can carry substantial risks, especially in young patients.
- Percutaneous nephrostomy offers a less invasive alternative for managing urinary tract obstructions.
Purpose:
- To evaluate the efficacy and safety of percutaneous nephrostomy for relieving upper urinary tract obstruction in pediatric patients.
- To assess the indications, complications, and outcomes of percutaneous nephrostomy in a pediatric population.
- To establish percutaneous nephrostomy as a preferred method for urgent urinary obstruction management in children.
Summary:
- Twelve percutaneous nephrostomies were performed on pediatric patients aged two months to 12 years for upper urinary tract obstruction.
- Common causes included congenital stenoses, postoperative scars, and impacted stones; emergency presentations often involved infection, palpable masses, or acute kidney insufficiency.
- The procedure, performed under sedation and local anesthesia with X-ray guidance, demonstrated a favorable safety profile with minimal complications, primarily mild hematuria and occasional catheter dislodgement.
Impact:
- Percutaneous nephrostomy provides immediate therapeutic and diagnostic relief for pediatric urinary tract obstructions, regardless of etiology.
- This minimally invasive technique allows for patient stabilization and preparation for subsequent definitive surgical management, potentially reducing operative risks.
- The study highlights percutaneous nephrostomy as the method of choice for urgent, temporary relief of upper urinary system obstructions in children.
Abstract:
During the period from April 1986 to March 1988 on the Pediatric Clinic in Belgrade a total of 12 percutaneous nephrotomies were performed to relieve obstruction of the upper urinary tract. The youngest patient was a two-month old with giant hydronephrosis, and the oldest was a 12-year old girl with an acute kidney obstruction caused by impaction of wedging the poured off stone. The most common reasons for obstruction of the upper urinary tract were congenital stenoses and postoperative scars, urethrocystoneostomia and pyeloplasty. The most frequent clinical manifestations in patients on whom nephrotomy was carried out as an emergency operation were infection, palpable tumor (cyst) and acute kidney insufficiency. Percutaneous nephrostomy was always performed with basal sedation and local infiltrative anesthesia under X-ray control. Surgery was necessary in all cases, but no complications needing surgical intervention occurred. Mild hematuria can be expected at almost every punction, so it should not be treated as a complication. Dislocation of the nephrostoma catheter immediately after surgery can be a complication which necessitates reintervention, but if this happens after more than ten days, the catheter can easily be replaced through the formed fistulous channel. In one case percutaneous placing of the catheter was not possible, so it was placed surgically in the kidney and skin to enable drainage of the infected urinome a month after rupture of the ureteropyelic segment. Percutaneous placing of a catheter through the nephrostoma is the method of choice for urgent and temporary relief of obstructions of the upper urinary system regardless of etiology, and this procedure achieves immediate therapeutic and, if necessary, diagnostic effect which enables recovery of the patient and preparation for definitive surgery which in such a situation could be hazardous.