'Is it time to standardise elective nephrostomies as day case procedures?'- a single-centre retrospective study

Elective percutaneous nephrostomies are performed in stable patients commonly to create urinary diversion following obstruction. The main complications are bleeding and urosepsis. There is currently minimal evidence on complication rates following elective nephrostomies and no national guidelines regarding admission length. The aim of this study is to establish complication rates following elective nephrostomy insertion and determine safety as a potential day-case procedure.

A retrospective study of patients undergoing elective nephrostomies within a 10-year period at our centre was included. Those with elective nephrostomies with additional ureteric or ileal conduit stents were also included. Complications were included if they occurred within 30 days of the nephrostomy.

239 patients underwent an elective nephrostomy in the 10-year period. The most common indication was cancer (91 patients). Overall complication rate was 8.39%. Three cases reported bleeding requiring transfusion and extended stay (1.26%). Seventeen cases needed IV antibiotics for presumed urosepsis (7.11%). There were no cases requiring embolisation, and no deaths were reported. There was no significant association between ureteric stenting and risk of complication.

Given the complication rate of elective nephrostomies remain relatively low, there remains a realistic possibility of standardising it as a day-case procedure. The use of IV antibiotics needs to be rationalised, and local protocols could be introduced to determine which patients are truly septic and require antibiotics. Those with a high risk of complications, such as those draining pus, may be admitted though the chance of this is likely to be low.