A Novel Method for Repositioning Suboptimally Preoperatively Placed Nephrostomy Tubes for Percutaneous...

Area of Science:

• Interventional Radiology
• Urology
• Nephrology

Background:

• Emergency nephrostomy tubes (NTs) are often ill-suited for subsequent percutaneous nephrolithotomy (PCNL).
• Repositioning NTs can avoid repeat renal access for PCNL.

Purpose of the Study:

• To describe and evaluate a novel method for adjusting preoperatively inserted NTs for PCNL.
• To assess the feasibility and safety of avoiding renal repuncture.

Main Methods:

• A retrospective review of 981 PCNLs identified patients with pre-existing NTs.
• A novel technique involved creating a new incision at the ideal puncture location (IPL), removing the NT, and tunneling a guidewire through the original NT tract to the IPL for PCNL tract preparation.
• Fluoroscopic guidance was used throughout the adjustment process.

Main Results:

• The novel adjustment approach was successfully used in 65% of cases (15/23) where NTs were unsuitable for PCNL.
• This method successfully repositioned the entry site and optimized the tract angle, avoiding renal repuncture in all 15 cases.
• The procedure was performed quickly (average 4 minutes) and without complications.

Conclusions:

• The described novel method for adjusting preoperatively inserted NTs is a feasible, safe, and effective technique.
• It successfully avoids renal repuncture for PCNL, potentially reducing patient morbidity.
• This approach offers a valuable alternative for managing patients requiring both nephrostomy and PCNL.