AUA 2018: The Utility of Emergently Placed Interventional Radiology Nephrostomy Tube Tracts for Subsequent Percutaneous Nephrolithotomy

San Francisco, CA USA (UroToday.com) Patients undergoing percutaneous nephrolithotomies require optimal percutaneous access to remove kidney stones larger than 2 cm. The primary goal for this access is to safely drain urine, usually completed by interventional radiology. Dr. Kaitlan Cobb of George Washington University and her research team observed the efficiency of nephrostomy tubes placed by IR to obtain percutaneous access in acute settings.

Using a multi-institutional database, patients who had PCNLs performed with NTs placed by IR were identified and retrospectively analyzed. All operative and post-operative data were obtained and used. To determine the level and types of complications for this procedure, a Clavien-Dindo system was used. The success of using NT to obtain access was defined as usable or unusable, depending if stone intervention was accomplished through the tube.

Overall, there were 36 patients who found to have NTs placed using IR before a PCNL was performed. These patients were treated for acute settings, such as urinary obstruction with infection, acute kidney injury, sepsis, and more. Of the 36 patients, only 11 cases indicated a NT was usable to obtain access for a PCNL. This means 30 cases were found unusable, for reasons such as indirect access or because the NT was directly in the pelvis.

Sine there was a low percentage of procedures that successfully used a NT placed by IR to carry out a PCNL without additional tracts, Dr. Cobb concluded that the operative team still requires new percutaneous access regardless if there is already a NT placed. It is important to bring up that sometimes when a NT is placed in the kidney, IR does not correctly identify if the NT is placed correctly in a calyx or not. Future studies are required to understand the accuracy of NT placement and use for PCNLs.

Presented by: Kaitlan Cobb, MD

Written by: Sherry Lu, Department of Urology, University of California-Irvine at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA
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