Efficacy and safety of diuretic infusion in saline for percutaneous nephrostomy in non-dilated renal collecting systems: A single-center experience

Objective: In this retrospective study, we aimed to investigate the etiology, success, and complication rate of percutaneous nephrostomy (PCN) in patients with non-dilated renal collecting system (NCT) using saline and diuretic agents.
Methods: PCN was performed on 62 kidneys from 35 patients with NCT. Prior to the procedure, a combination of saline and furosemide infusion was administered. Several parameters were evaluated, including pre- and post-procedure levels of creatinine and blood urea nitrogen, fluoroscopy time, total air kerma (TAK), dose area product (DAP), puncture number, success rate, and complication rate.
Results: Fistula was the most common etiology and was detected in 29 out of 62 kidneys. The other most common cause was ureteral injury, detected in 21 out of 62 kidneys. The success rate of our procedures was 96.7%, and the rate of minor complications was 1.7%. Transient macroscopic hematuria was one of the minor complications observed in one patient. No major complications were observed. During each procedure, the average number of needle passes was 1.44 ± 0.5 (range: 1–3). The average duration of the complete procedure was 13.17 ± 6.46 minutes (range: 8–31 minutes). The mean fluoroscopy time was 2.37 minutes (range: 0.8–11.6 minutes). In terms of radiation exposure, the mean DAP was 166.94 ± 148.5 μGy·m² (range: 3.93–666.59 μGy·m²) with a median of 127.04 μGy·m², and the cumulative dose (TAK) was 72.43 mGy (range: 12–342 mGy) with a median of 42.05 mGy, respectively.
Conclusion: Diuretic infusion in saline is a safe and beneficial method for PCN in NCT. With its low complication rate and high success rate, PCN provides rapid treatment for various etiologies with the potential to address conditions such as fistula, ureteral injury, and urosepsis in the collecting system, which may otherwise have devastating consequences.

Dilate olmayan renal toplayýcý sistemlerde perkütan nefrostomi için salin içinde diüretik infüzyonunun etkinliði ve güvenliði: Tek merkez deneyimi

Amaç: Bu retrospektif çalýþmada, dilate olmayan böbrek toplayýcý sisteminde salin ve diüretik infüzyonu sonrasýnda perkütan nefrostomi (PKN) iþleminin etkinliðini ve güvenilirliðini ortaya koymayý amaçladýk.
Metod: Geniþlememiþ renal toplayýcý sistemi olan 35 hastanýn 62 böbreðine salin ve furosemid infüzyonu sonrasýnda PKN iþlemi uygulandý. Ýþlem öncesi ve sonrasý kreatinin ve üre seviyeleri, floroskopi süresi, toplam hava kerma (THK), doz alan çarpýmý (DAÇ), ponksiyon sayýsý, baþarý oraný ve komplikasyon oraný dahil olmak üzere çeþitli parametreler deðerlendirildi.
Sonuçlar: En sýk etiyolojik neden fistül olup 62 böbreðin 29'unda saptandý. Diðer en sýk neden üreter yaralanmasýydý ve 62 böbreðin 21'inde saptandý. Ýþlemlerimizin baþarý oraný %96,7 olarak ölçülürken; minör komplikasyonlar %1,7 olarak hesaplandý. Bir hastamýzda minör komplikasyon olarak geçici makroskopik hematüri geliþti. Hiçbir majör komplikasyon gözlenmedi. Her prosedür sýrasýnda ortalama iðne geçiþ sayýsý 1,44 ± 0,5 (aralýk: 1–3) idi. Tüm prosedürün ortalama süresi 13,17 ± 6,46 dakikaydý (aralýk: 8–31 dakika). Ortalama floroskopi süresi 2,37 dakikaydý (aralýk: 0,8–11,6 dakika). Radyasyona maruz kalma açýsýndan, ortalama doz alan çarpaný (DAÇ) 166,94 ± 148,5 μGy·m² (aralýk: 3,93–666,59 μGy·m²) ve medyan 127,04 μGy·m²; kümülatif doz (toplam hava kerma) ise 72,43 mGy (aralýk: 12–342 mGy) ve medyan 42,05 mGy olarak saptanmýþtýr.
Tartýþma: Salin ve diüretik infüzyonu, dilate olmayan pelvikalisiyel sistemlerde PKN için uygulanabilen etkili ve güvenilir bir yöntemdir. Düþük komplikasyon oraný ve yüksek baþarý oraný ile PKN, fistül, üreter yaralanmasý ve ürosepsis gibi çeþitli etiyolojilerin etkin tedavisini saðlamada baþarýlý sonuçlar ortaya koymaktadýr. (NCI-2023-7-7)