Percutaneous nephrostomy with real-time sonographic guidance

Purpose: Percutaneous nephrostomy (PCN) is an effective method for achieving temporary drainage of the obstructed urinary system and is usually performed under fluoroscopic guidance alone or more commonly under combined sonographic and fluoroscopic guidance. We undertook a retrospective analysis of 273 PCNs performed solely under ultrasound (US) guidance with the aim of evaluating the technique and the safety and efficacy of the procedure. Material and Methods: A total of 273 PCN procedures in 267 patients were performed under real-time US guidance using the Seldinger technique. The indications for PCNs comprised benign (n=215) and malignant (n=46) urinary obstruction, and urinary fistulae (n=6). Results: PCN was successful in 269 of the 273 attempts (98.5%). Satisfactory catheter placement was achieved in 245 of the 269 procedures (91.1%) under US guidance. Fluoroscopic assistance for catheter repositioning was required in 24 PCNs owing to the unsatisfactory position of the catheter tip. Major complications occurred in 15 patients (5.6%). Catheter dislodgement and catheter blockage was seen in respectively 12.6% and 3.3% of procedures. Conclusion: In most patients, PCN can be performed safely using real-time sonographic guidance.