Inadvertent Discontinuation of Percutaneous Nephrostomy Catheters in Adult Native Kidneys: Incidence and Percutaneous Management

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PURPOSE

To evaluate the incidence and consequences of complete inadvertent percutaneous nephrostomy catheter discontinuation in native kidneys of adults. In addition, this study evaluated the success rate of nephrostomy tract recannulation.

MATERIALS AND METHODS

Retrospective analysis was performed in adult patients who underwent percutaneous nephrostomy between January 2000 and December 2005. Patients' conditions were evaluated for complete inadvertent discontinuation of use of the nephrostomy catheters and success of subsequent recannulation procedures. Habitual discontinuation was defined by three catheter discontinuation episodes in one patient. Conditions of patients with inadvertent discontinuation were assessed for major complications before and after the recannulation, including the need for de novo nephrostomy to reestablish clinically needed access. The incidences of inadvertent discontinuation and primary assisted recannulation tract maintenance were calculated according to the Kaplan-Meier method. Successful versus unsuccessful recannulation procedures were compared for tract age, length of time the drain was out of the tract, and catheter diameter with use of the Mann-Whitney U test.

RESULTS

A total of 283 patients underwent 325 percutaneous nephrostomies. The inadvertent catheter discontinuation rates at 6, 12, 24, and 36 months were 26%, 36%, 53%, and 62%, respectively. For the same time intervals, the primary recannulation assisted tract maintenance rates were 94%, 86%, 77%, and 72%, respectively. Habitual discontinuation was seen in 3.2% of the total population and 19.1% of discontinuation cases. The technical success rates of all and first-time recannulations were 85% and 74%, respectively. Tract maturity was the only variable that was statistically significant between successful and unsuccessful recannulations (P < .0001). A total of 3.5% of patients required new nephrostomies.

CONCLUSION

Despite the high incidence of inadvertent discontinuation of nephrostomy catheters, the major complication rate was only 3.5%, indicating the efficacy of tract recannulation, especially in mature tracts.

Section snippets

MATERIALS AND METHODS

A retrospective review was performed of charts and radiology reports of all adult patients who underwent nephrostomy catheter placement in native (ie, nontransplanted) kidneys between January 2000 and December 2005. Patients who underwent nephroureteral stent placement were not included in the study. A research subject review board exemption was obtained under the category of secondary use of preexisting data.

RESULTS

A total of 329 adult patients underwent 385 PCN catheter or percutaneous nephroureteral stent placement procedures. Forty-six patients with 60 nephroureteral stents (30% bilateral) were excluded from the study. The remaining 283 patients underwent 325 PCN catheter placements (tip of nephrostomy drain/catheter in the pelvicaliceal system of the kidney) during the study period. There were 150 women and 133 men, with a mean age of 61 years (range, 18–97 y). Forty-two patients (15%) underwent

DISCUSSION

Technical and short-term postprocedural success are achieved in more than 90% of PCN cases (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14). However, inadequate drainage resulting from mechanical problems with indwelling catheters after PCN is not uncommon and can be frustrating (1, 2, 3). Mechanical problems leading to catheter malfunction are classified into catheter blockage, dislodgment, and catheter/pericatheter urine leaks (2). Maintenance of these drainage catheters for prolonged periods

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M.G.D. is an unpaid speaker for Boston Scientific, Natick, MA. None of the other authors have identified a conflict of interest.

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