DOCSLIB.ORG

Percutaneous Nephrostomy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Percutaneous Nephrostomy SEMINARS IN INTERVENTIONAL RADIOLOGY VOLUME 17, NUMBER 4 2000 Percutaneous Nephrostomy Michael M. Maher, M.D., Timothy Fotheringham, M.D., and Michael J. Lee, M.D. ABSTRACT Percutaneous nephrostomy (PCN) is now established as a safe and effective early treatment for patients with urinary tract obstruction. In experienced hands, PCN is usually successful and is associated with low complication rates. This article discusses all aspects of PCN, including the indications and contraindications to PCN, patient preparation, the techniques employed for gaining access to the urinary tract, and placement of the PCN tube. In addition, we discuss the complications of PCN and possible ways of avoiding them, as well as the care of patients following PCN. Keywords: Percutaneous nephrostomy, renal failure, pyonephrosis Urinary tract obstruction invariably requires eral anesthesia is avoided and surrounding organs treatment, and indications for immediate or urgent can be imaged and avoided during PCN. In expert intervention include clinical and laboratory signs of hands, PCN is associated with a major complication underlying sepsis and clinical or radiological signs rate of 4 to 5%4 and a minor complication rate of of pyonephrosis. Urgent intervention is also manda- approximately 15%.1 PCN is usually faster, less ex- tory for the treatment of life-threatening biochemi- pensive, and less likely to be associated with compli- cal abnormalities associated with the rapid onset of cations than is surgery.5 In the current era, PCN renal failure. also allows access to the urinary tract for more In the past decade, image-guided PCN has re- definitive treatment of underlying pathologies such placed the conventional surgical approach for the as percutaneous nephrolithotomy (PCNL) for temporary drainage of urinary tract obstruction. treating urinary tract calculi and the placement of PCN is now established as a safe and effective initial ureteric stents for treating malignant urinary tract treatment for patients with urinary tract obstruc- obstruction. The type of image guidance used dur- tion.1–3 The percutaneous approach has many ad- ing PCN frequently varies depending on imaging fa- Downloaded by: University of Florida. Copyrighted material. vantages over surgery, including the fact that gen- cilities available at the institution and, more impor- Objectives Upon completion of this article, the reader will understand how to perform percutaneous nephrostomy safely and avoid complications. Accreditation Tufts University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. TUSM takes full responsibility for the content, quality, and scientific integrity of this continuing education activity. Credit The Tufts University School of Medicine designates this educational activity for a maximum of 1.0 hours credit toward the AMA Physicans Recognition Award in category one. Each physician should claim only those hours that he/she actually spent in the educational activity. Department of Radiology, Beaumont Hospital and the Royal College of Surgeons Medical School, Dublin, Ireland Reprint requests: Michael J. Lee, Department of Radiology, Beaumont Hospital and the Royal College of Surgeons Medical School, Beaumont Hospital, Dublin 9, Ireland. Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662. 0739-9529,p;2000,17,04,329,340,ftx,en; sir00085x. 329 SEMINARS IN INTERVENTIONAL RADIOLOGY VOLUME 17, NUMBER 4 2000 tantly, the preference of the operator. Modern quently aid in deciding the optimal timing of the nephrostomy is usually performed in the fluo- procedure and can optimize the patient’s biochemi- roscopy suite using a combination of ultrasound cal and other parameters prior to the procedure. It and fluoroscopic guidance. However, in recent is important that the urologist is available should times both computed tomography (CT)6,7 and mag- any complications occur that might require urgent netic resonance imaging (MRI)8 have been added surgical intervention. to the list of imaging modalities used to facilitate Prothrombin time and activated partial throm- PCN. boplastin time estimations should be performed prior to PCN, and, if abnormal, attempts should be made to optimize coagulation and other hemato- INDICATIONS logic parameters prior to the procedure.9–11 The procedure should be explained to the patient and The most common indications for PCN in- his or her relatives prior to the procedure, and po- clude benign obstruction resulting from ureteric tential complications such as hemorrhage, urinary stones and malignant obstruction resulting from leakage, septicaemia, and death should be men- carcinoma of the bladder, prostate, and cervix. tioned prior to the examination. Good peripheral Ureteric obstruction can also result from extrinsic intravenous access should be ensured prior to the compression of the ureters by metastatic deposits procedure. Many authors initially recommended from carcinoma of the uterus, colon, cervix, breast, the use of antibiotics before PCN in instances in and abdominal lymphoma. Another common indi- which the patient was at high risk of sepsis, in other cation for PCN is iatrogenic damage to the ureter, words, suspected pyonephrosis.4,5 More recently, an- which most commonly occurs following abdominal tibiotics have been recommended for all patients re- hysterectomy or right or left hemicolectomy or fol- gardless of preprocedure risk profile, with antibiotic lowing instrumentation of the ureter during endo- dosage depending on the perceived risk of sepsis.4 scopic treatment of ureteric stones. Other less com- Our practice is to prescribe preprocedure antibi- mon indications for PCN include the relief of otics to the patients with leukocytosis or fever. We do terminal vesicovaginal fistula and ureteral fistulae. not routinely give antibiotics for noninfected pa- The most common indication for emergency tients. A broad-spectrum cephalosporin is suitable nephrostomy is acute sepsis is an obstructed urinary for administration prior to the procedure. When tract secondary to pyonephrosis. The other most fungal infection is suspected, this should also be cov- common reason for emergency nephrostomy is ered by the antibiotic regimen administered prior to acute renal failure secondary to acute obstructive the procedure. For sedation and pain relief, we use uropathy. The most worrying biochemical abnor- midazolam and fentanyl in incremental amounts of mality associated with renal failure, which can lead 1 mg and 50 to 100 ␮g, respectively. Patients are to a life-threatening cardiac arrhythmia, is severe monitored using blood pressure and pulse oximetry hyperkalaemia. If there is no evidence of either apparatus throughout the procedure. acute sepsis or acute hyperkalaemia, PCN can be A nurse trained in the monitoring of critically Downloaded by: University of Florida. Copyrighted material. performed on the next elective interventional list. ill patients should be available during the proce- dure to monitor blood pressure and pulse oximeter readings. PATIENT SELECTION AND PREPARATION In most cases of acute urinary tract obstruc- ANTEGRADE PYELOGRAPHY tion, PCN is used as a temporizing measure until definitive medical or operative correction of the Antegrade pyelography involves the insertion cause of obstruction can be carried out. The aim of of a needle into the pelvicalyceal system and the PCN is immediate treatment of acute pyonephrosis opacification of the collecting system with contrast or acute hyperkalemia, allowing stabilization of the material to clearly delineate the pelvicalyceal sys- critically ill patient prior to definitive investigation tem and ureter.12 The routine performance of ante- of the cause of ureteric obstruction. The placement grade pyelography has two main advantages. Firstly of a PCN catheter allows the kidneys to regain func- the pelvicalyceal system can be opacified and dis- tion and relieves pyonephrosis, septicemia, and as- tended, which greatly aids access to the pelvi- sociated biochemical abnormalities. calyceal system. Secondly the presence of the ante- The treatment of acute urinary tract obstruc- grade needle in the pelvis during the procedure tion requires a multidisciplinary approach, and allows the pelvicalyceal system to be reopacified prior consultation with the urologist and or and distended should decompression occur at any nephrologist is advisable. The nephrologist can fre- time. 330 PERCUTANEOUS NEPHROSTOMY—Maher et al. The anatomy at the renal hilum is fundamental ployed. Alternatively, if there is marked hydro- to the performance of antegrade pyelography. It nephrosis, ultrasound can be performed prior to must be remembered that the renal vein, artery, puncture and the site can be marked. The needle and ureter run anterior to posterior in this order at can then be inserted without the necessity for real- the renal hilum. In addition, the colon can occa- time ultrasound guidance. In the case of a mildly or sionally be found posterior to the kidney, which can moderately obstructed kidney, real-time ultrasound result in colonic injury during PCN. Ultrasound ex- guidance is necessary. amination prior to needle puncture is helpful in de- Most centers use either a 20- or 22-gauge nee- termining whether the colon is posterior to the kid- dle. Our preference, however, is for the 20-gauge ney. CT has been advocated either prior to PCN or
Load more

Recommended publications
  • Percutaneous Nephrostomy and Sclerotherapy with 96% Ethanol for the Treatment of Simple Renal Cysts: Pilot Study Mustafa Kadıhasanoğlu1, Mete Kilciler2, Özcan Atahan3
    İstanbul Med J 2016; 17: 20-3 Original Article DOI: 10.5152/imj.2016.20981 Percutaneous Nephrostomy and Sclerotherapy with 96% Ethanol for the Treatment of Simple Renal Cysts: Pilot Study Mustafa Kadıhasanoğlu1, Mete Kilciler2, Özcan Atahan3 Introduction: The objectives of this study was to evaluate the safety and efficacy of aspiration with percutaneous nephrostomy tube and sclerotherapy with 96% ethanol for simple renal cyst. Methods: Between 2011-2014, 34 patients with symptomatic renal cysts were included in the study. Mean age was 52.3±4.6 years (range, 39-72 years). The Abstract patients had only flank pain. Procedure was performed with ultrasound guidance and under fluoroscopic control. After puncture with 18 G angiography needle, guide-wire was advanced to the collecting system. An 14Fr nephrostomy catheter was then advanced over the guide wire. After taking cystography 96% ethyl alcohol was injected into the cyst and drained amount 10%. We continued daily to inject same amount of alcohol postoperatively until the drainage was less than 50 mL. 6th months and yearly follow-up were performed with ultrasound.. Results: Percutaneous access was achieved in all patients. Cysts were unilateral, single and with a mean diameter 9.1±3.2 cm (range, 7-16 cm). Median drained volume was 212 mL (200-1600 mL) and median the injected ethanol volume was 54 mL (20- 160 mL). Radiological improvement at the end of the 6th month was amount 94.1% and 91.1% at the end of the 1st year while 83.3% of patients had symptomatic decline. There was no major complication after the procedure.
    [Show full text]
  • ICD-10 Coding Clinic Corner: Accountability Act of 1996 (HIPAA) Is 413.65(A)(2): Diabetes and Osteomyelitis
    Issue No. 6 Volume No. 2 September 2015 New and Revised Place of Service TABLE of CONTENTS Codes for OutpatientNote Hospital from Tony New and Revised Place of Joette P. Derricks, MPA, CMPE, CHC, CPC, CSSGB Service Codes for Outpatient Joh Vice President of Regulatory Affairs & Research Hospital ..................................... 1 MiraMed Global Services ERCP with Exchange of a Common Bile Duct Stent .......... 3 Any health insurer subject to the policy. Contractor editing shall Laparoscopic Procedure: An uniform electronic claim transaction treat POS 19 and POS 22 in the Education .................................. 5 and code set standards under the same way. The definition of a Health Insurance Portability and “campus” is found in Title 42 CFR ICD-10 Coding Clinic Corner: Accountability Act of 1996 (HIPAA) is 413.65(a)(2): Diabetes and Osteomyelitis ..... 7 required to make changes to the Campus means the physical Place of Service (POS) code from the Stars of MiraMed ...................... 8 area immediately adjacent to POS code set maintained by the the provider’s main buildings, Are You a Good Auditor? ......... 9 Centers for Medicare and Medicaid other areas and structures that Services (CMS) effective January 1, Coding Case Scenario ............. 11 are not strictly contiguous to 2016. the main buildings but are The POS code set provides setting located within 250 yards of the If you have an article information necessary to main buildings, and any other appropriately pay Medicare and areas determined on an or idea to share for The Medicaid claims. Other payers may individual case basis, by the Code , please submit to: or may not use the POS codes in the CMS regional office, to be part Dr.
    [Show full text]
  • (Mitomycin) for Pyelocalyceal Solution with a Nephrostomy Tube
    INSTRUCTION GUIDE for Instillation of JELMYTO® (mitomycin) for pyelocalyceal solution with a Nephrostomy Tube Important Information Please refer to the FDA-approved Prescribing Information and Instructions for Administration (IFA) for information about JELMYTO. JELMYTO is a cytotoxic drug. Follow applicable special handling and disposal procedures. This Instruction Guide contains supplemental information on how to instill JELMYTO via a nephrostomy tube. These instructions are derived from materials from the OLYMPUS Clinical Trial. It is important to note that in the OLYMPUS Clinical Trial, no investigators utilized a nephrostomy tube as the mode of administration. Important Information Regarding Nephrostomy Instillation Note: Follow practice/institutional protocol regarding placement for nephrostomy tube and time allowance for healing before proceeding with JELMYTO instillation. • Prior to administration, implement your clinic's practice for draining the patients' urine. • A Silicon or Silastic percutaneous nephrostomy tube with molded Luer lock connector and locking loop must be placed prior to installation of JELMYTO. Latex should not be used, due to risk of rupture. Instillation Instructions A. Measure the Kidney Volume Before the First Instillation The Instillation Volume will be equal to the patient’s kidney volume. If the kidney volume is already known, proceed to Section B. If the kidney volume is NOT known, or needs to be reassessed, use the following steps: 1. Perform an antegrade pyelogram using diluted contrast (50%) so that the entire renal pelvis and calyces are observed and contrast starts to flow below the ureteropelvic junction (UPJ). 2. Record the volume of contrast injected at this point. 3. Allow the contrast to drain from the kidney.
    [Show full text]
  • Percutaneous Nephrostomy
    Page 1 of 6 Percutaneous Nephrostomy (PCN) Tube Related Infections Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient's care. This algorithm should not be used to treat pregnant women. Local microbiology and susceptibility/resistance patterns should be taken into consideration when selecting antibiotics. CLINICAL EVALUATION PRESENTATION Patient presentation suspicious for PCN infection: ● Lower UTI: dysuria, frequency, urgency and/or suprapubic pain ● Upper UTI: fever/chills, leukocytosis and/or CVA tenderness (with or without lower UTI symptoms) ● PCN exit site infection: local signs for erythema, ● Renal ultrasound or CT abdomen and pelvis with contrast warmth, tenderness and/or purulence ● Consider Infectious Diseases (ID) consult ● See Sepsis Management - Adult algorithm Yes Labs: Does ● CBC with differential, patient exhibit at BUN, creatinine least two modified ● Blood cultures SIRS criteria2 and ● Urine analysis and urine 1 hemodynamic ● Start empiric IV antibiotics (refer to Page 2) culture from urethral 3 instability ? ● Consider CT abdomen and pelvis with and PCN sites No contrast to rule out hydronephrosis, Fever, chills, Yes pyelonephritis and renal
    [Show full text]
  • Nephrostomy Tubes
    Charlotte Derr, MD, FACEP Tubes and Lines Clogged or Broken: Trouble Shooting Tubes and Lines Charlotte Derr, MD, FACEP Associate Program Director • Director of Emergency Ultrasound University of South Florida Emergency Medicine Residency Program Central Venous Catheters Types of Central Venous Catheters (CVC) Tunneled o Used for medium or long-term access requirements . Chemotherapy . TPN . Hemodialysis o Single, double, or triple lumen o Usually inserted via access to a neck vein o May be placed percutaneously by interventional radiology (IR) or surgically o The catheter is tunneled through the adjacent subcutaneous tissues to the vein then exits the skin over the chest wall o Likely provides a barrier to ascending infection o Will adhere to subcutaneous tissues over time o Less chance for dislodgement but removal may be difficult o Examples . Hickman, Groshong, Broviac catheters . Totally Implanted Venous Access Devices (iVADs or “portacath”) Has a reservoir attached to the catheter that is buried in the subcutaneous tissue of the chest wall Accessed percutaneously via a noncoring needle Can be accessed up to 1,000 times Has lower infection rates than external catheters Best for intermittent therapies (e.g. factor or enzyme infusions) Tolerates immersion for bathing Non-tunneled o Placed directly into the vein via a skin incision or puncture overlying the vein o Placed in the neck, upper chest, extremities o Examples . Triple lumen polyurethane catheters, percutaneous sheath introducer kits Shorter-term therapies, such as during hospitalization 1 Charlotte Derr, MD, FACEP Tubes and Lines Indications o Extended antibiotic treatment o Repeated blood sampling o Vasopressors o TPN o Hemodynamic monitoring (pulmonary artery catheters) .
    [Show full text]
  • Suprapubic Cystostomy and Nephrostomy Care This Brochure Will Help You Learn How to Care for Your Catheter
    Northwestern Memorial Hospital Patient Education CARE AND TREATMENT Suprapubic Cystostomy and Nephrostomy Care This brochure will help you learn how to care for your catheter. The following are general guidelines. If you have any questions or concerns, please ask your physician or nurse. Wash your A suprapubic cystostomy is a surgical Figure 1. Suprapubic hands carefully opening made into the bladder directly cystostomy above the pubic bone. A tube (catheter) before and is inserted into the bladder. The catheter is held in place by a balloon or sutures. after changing Urine flows through the catheter into a Catheter drainage bag (Figure 1). the bandage or A nephrostomy tube works much the same way, except: Tape drainage bag. ■ The surgical opening is made into the kidney. Drainage bag ■ The catheter is held in place by sutures and/or a wax wafer with a catheter holder (Figure 2). Figure 2. Nephrostomy General guidelines It is important to keep the area around the catheter site clean. Change the gauze bandage every day or any time it comes off. Change the catheter tape when it becomes soiled or loose. When taping the catheter to your skin, make sure the catheter is not kinked. If your skin is sensitive to adhesive bandage tape, use a Catheter non-allergenic tape. Wash your hands carefully before and after changing the bandage Tape or drainage bags. Avoid pulling on the catheter or tube. Do not clamp your catheter or tube. You may notice dried crusts around the outside of the catheter. These can be removed by gently wiping with a wet washcloth.
    [Show full text]
  • Icd-9-Cm (2010)
    ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular
    [Show full text]
  • Outcome of Percutaneous Nephrostomy in Children with Ureteropelvic Junction Obstruction Mohammad Mahfuzur Rahman Chowdhury1, Rifat Zaman2, Md
    OUTCOME OF PERCUTANEOUS NEPHROSTOMY IN CHILDREN WITH URETEROPELVIC JUNCTION OBSTRUCTION MOHAMMAD MAHFUZUR RAHMAN CHOWDHURY1, RIFAT ZAMAN2, MD. AMANUR RASUL1, AKM SHAHADAT HOSSAIN1, SHAFIQUL ALAM CHOWDHURY1, MD. MIZANUR RAHMAN1 1Department of Urology, Dhaka Medical College & Hospital, Dhaka, 2Department of Pediatrics, Dhaka Medical College Hospital, Dhaka. Abstract: Introduction and objectives: Congenital ureteropelvic junction obstruction (UPJO) is the most common cause of hydronephrosis. Management protocols are based on the presence of symptoms and when the patient is asymptomatic the function of the affected kidney determines the line of treatment. Percutaneous nephrostomy (PCN) became a widely accepted procedure in children in the 1990s. The aim of the study was to evaluate the results of performing percutaneous nephrostomy (PCN) in all patients with UPJO and split renal function (SRF) of less than 10% in the affected kidney, because the management of such cases is still under debate. Methods:This prospective clinical trial was carried out at Dhaka Medical College Hospital from January 2014 to December 2016. Eighteen consecutive patients who underwent PCN for the treatment of unilateral UPJO were evaluated prospectively. In these children, ultrasonography was used for puncture and catheter insertion. Local anesthesia with sedation or general anesthesia was used for puncture. Pig tail catheters were employed. The PCN remained in situ for at least 4 weeks, during which patients received low-dose cephalosporin prophylaxis. Repeat renography was done after 4 weeks. When there was no significant improvement in split renal function (10% or greater) and PCN drainage (greater than 200 ml per day) then nephrectomies were performed otherwise pyeloplasties were performed. The patients were followed up after pyeloplasty with renograms at 3 months and 6 months post operatively.
    [Show full text]
  • Percutaneous Nephrostomy and Antegrade Pyelography
    Marmara Medical Journal Volume 3 No 4 October 1990 PERCUTANEOUS NEPHROSTOMY AND ANTEGRADE PYELOGRAPHY MAkinci, MD.** / A.Kadioglu, M.D.* * * * / I.Nane, M.D.* * * / COzsoy. M.D.* / A.R.Ersay MD.* * * * * Professor, Department o f Urology, Istanbul Medical Faculty, University o f Istanbul, Istanbul, Turkey. ** Associate Professor, Department o f Urology, Istanbul Medical Faculty, University o f Istanbul, Istanbul, Turkey *** Specialist, Department o f Urology, Istanbul Medical Faculty, University o f Istanbul, Istanbul, Turkey **** Research Assistant, Department o f Urology, Istanbul Medical Faculty, University o f Istanbul, Istanbul, Turkey SUMMARY Between October 1986 and January 1989, 66 per­ cases in our clinic. The ages o f the patients varied cutaneous nephrostomy (PCN) were performed in 47 from 4 to 43 years and 9 patients were in the pediatric patients in our clinic. Nine cases were children and group The indications for PCN in our series are shown the remainder were adults. Seven of nine children had in table I. bilateral vesico-ureteric reflux and the other two cases had idiopathic megaureter 19 of our adult patients had Basic haematologic parameters were obtained in all bladder tumor, nine patients had cervix ca. three cases patients before the procedure. W e used antibiotic pro­ had carcinoma of the prostate, two cases had tuber­ phylaxis routinely in our patients. Ultrasonic scann­ culosis pyenephrose, two patients had stone-way, ing was used to localise renal pelvis, the appropriate three cases had lymphoma and another two cases caliyx for nephrostomy tract and to measure the tumor of the ureter. Local anesthesia was used in all distance from skin to renal pelvis and caliyx.
    [Show full text]
  • Is Double J Stenting Or Percutaneous Nephrostomy More Suitable For
    ISSN 2465-8243(Print) / ISSN: 2465-8510(Online) https://doi.org/10.14777/uti.2019.14.3.87 Original Article Urogenit Tract Infect 2019;14(3):87-92 http://crossmark.crossref.org/dialog/?doi=10.14777/uti.2019.14.3.87&domain=pdf&date_stamp=2019-12-25 Is Double J Stenting or Percutaneous Nephrostomy More Suitable for Maximizing the Clinical Effects of Temporary Urinary Diversion for Acute Pyelonephritis with a Complicated Ureteral Stone? Jeonghyouk Choi, Taesoo Choi, Dong-Gi Lee, Gyeong Eun Min, Hyung Lae Lee, Koo Han Yoo Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea Purpose: This study compared the clinical benefits of double J (DJ) ureteral stenting Received: 18 September, 2019 Revised: 25 October, 2019 with percutaneous nephrostomy (PCN) for the management of acute pyelone- Accepted: 14 November, 2019 phritis (APN) with complicated ureteral stones. Materials and Methods: The records of 85 patients with complicated APN between December 2006 and July 2017 were reviewed retrospectively. Sixty one patients who underwent DJ or PCN for the management of acute urinary obstruction were enrolled in this study. Some of the participants were excluded for concurrent renal stones, multiple ureteral stones, ureteral stricture, malignancy, and anatomical anomalies. The patient and stone characteristics and peri-procedural laboratory test results of the groups were compared. The success rate, depending on the type of urinary diversion and the presence of immediate complications, were also anal- yzed. Results: In this study, 19 patients underwent DJ stenting, and 42 patients underwent PCN as a transient urinary diversion. No failed procedures or immediate com- plications requiring subsequent intervention were encountered (Clavien–Dindo grade II-V).
    [Show full text]
  • Obstruction of the Urinary Tract 2567
    Chapter 540 ◆ Obstruction of the Urinary Tract 2567 Table 540-1 Types and Causes of Urinary Tract Obstruction LOCATION CAUSE Infundibula Congenital Calculi Inflammatory (tuberculosis) Traumatic Postsurgical Neoplastic Renal pelvis Congenital (infundibulopelvic stenosis) Inflammatory (tuberculosis) Calculi Neoplasia (Wilms tumor, neuroblastoma) Ureteropelvic junction Congenital stenosis Chapter 540 Calculi Neoplasia Inflammatory Obstruction of the Postsurgical Traumatic Ureter Congenital obstructive megaureter Urinary Tract Midureteral structure Jack S. Elder Ureteral ectopia Ureterocele Retrocaval ureter Ureteral fibroepithelial polyps Most childhood obstructive lesions are congenital, although urinary Ureteral valves tract obstruction can be caused by trauma, neoplasia, calculi, inflam- Calculi matory processes, or surgical procedures. Obstructive lesions occur at Postsurgical any level from the urethral meatus to the calyceal infundibula (Table Extrinsic compression 540-1). The pathophysiologic effects of obstruction depend on its level, Neoplasia (neuroblastoma, lymphoma, and other retroperitoneal or pelvic the extent of involvement, the child’s age at onset, and whether it is tumors) acute or chronic. Inflammatory (Crohn disease, chronic granulomatous disease) ETIOLOGY Hematoma, urinoma Ureteral obstruction occurring early in fetal life results in renal dys- Lymphocele plasia, ranging from multicystic kidney, which is associated with ure- Retroperitoneal fibrosis teral or pelvic atresia (see Fig. 537-2 in Chapter 537), to various
    [Show full text]
  • ITPE Sample.Fm
    Chapter 2: Introduction to ICD-10-PCS STRUCTURE AND COMPONENTS OBJECTIVES This chapter will provide an overview of the structure of ICD-10-PCS and how In this chapter you will learn: its components make up each code. In addition, the PCS coding conventions contained in the official ICD-10-PCS Coding Guidelines will be discussed. The • The basic structure of each ICD-10-PCS code complete set of official guidelines may be found in appendix A at the end of this • The general definition of each of book. the seven PCS characters • About the three components of The ICD-10-PCS system is a completely different type of coding system than PCS (Index, Tables, List of Codes) many coding professionals may be familiar with. Instead of looking up codes in • The structure of the PCS tables the index and verifying a fixed code in the tabular list that most likely matches from which codes are constructed the documentation in medical record, PCS codes are constructed from • How to use the alphabetic index component parts found in tables. Every PCS code is made up of seven to initiate code construction characters, and each character represents a distinct value. An alphabetic index is used to direct the coder to a specific PCS table, where the remaining code values are selected. By utilizing a table format, exponentially more codes may be constructed in PCS than were available in ICD-9-CM volume 3. Compared to the current “look-up” process for ICD-9-CM, coding in ICD-10-PCS requires a process of combining semi-independent values from among a selection of values, according to the rules governing the construction of codes.
    [Show full text]