Purpose: We aimed to investigate the effect of percutaneous nephrostomy (PCN) implementation on the second ureteroscopy (URS) outcomes after a failed URS.
Materials and Methods: The data of four hundred forty-eight patients with an unsuccessful URS history were evaluated. Patients were divided into two groups; patients who underwent PCN before second URS (Group A) and patients who did not (Group B). We compared the stone access rate in the second URS between the two groups according to patient and stone characteristics and operative data. Then, group A was subdivided into two groups according to stone access as; access succeeded (Group A1) and access failed (Group A2). We also compared stone access rates between these two groups in terms of gender, age, body mass index, stone size, side, location, grade of hydronephrosis and PCN duration. All data were available immediately after surgery and obtained from patient files and the outcome assessment was performed during the study period.
Results: Stone access rate was higher in group A than group B (143/196 vs 41/252, P = .0018). Mean nephrostomy duration and mean hydronephrosis grade were significantly higher and mean stone size was significantly lower in group A1 than group A2 (18.74 vs 9.62 days, P < .001; grade 3.25 vs 1.21, P = .038; and 7.286 vs 12.631 mm P < .001, respectively).
Conclusion: PCN is a favourable intervention after a failed URS and increases the success rate of the second operation with ease of implementation and minimal morbidity.
Meldrum K, Mathews R, Gearhart J. Hugh Hampton Young: a pioneer in pediatric urology. J. urol. 2001;166:1415-7.
Alenezi H, Denstedt JD. Flexible ureteroscopy: Technological advancements, current indications and outcomes in the treatment of urolithiasis. Asian Journal of Urology. 2015;2:133-41.
Tawfiek ER, Bagley DH. Management of upper urinary tract calculi with ureteroscopic techniques. Urology. 1999;53:25-31.
Rassweiler J, Rassweiler M-C, Klein J. New technology in ureteroscopy and percutaneous nephrolithotomy. Current opinion in urology. 2016;26:95-106.
Chew B, Denstedt J. Ureteroscopy and retrograde ureteral access. Campbell-Walsh urology. 9th ed. Philadelphia: Saunders. 20071508-25.
Goodwin WE, Casey WC, Woolf W. Percutaneous trocar (needle) nephrostomy in hydronephrosis. J Am Med Assoc. 1955;157:891-4.
Montvilas P, Solvig J, Johansen TEB. Single-centre review of radiologically guided percutaneous nephrostomy using “mixed” technique: success and complication rates. Eur J Radiol. 2011;80:553-8.
Lynch MF, Anson KM, Patel U. Percutaneous nephrostomy and ureteric stent insertion for acute renal deobstruction Consensus based guidance. British Journal of Medical and Surgical Urology. 2008;1:120-5.
Shields JM, Bird VG, Graves R, Gómez-Marín O. Impact of preoperative ureteral stenting on outcome of ureteroscopic treatment for urinary lithiasis. J. urol. 2009;182:2768-74.
Beetz R, Bökenkamp A, Brandis M, et al. Diagnosis of congenital dilatation of the urinary tract. Consensus Group of the Pediatric Nephrology Working Society in cooperation with the Pediatric Urology Working Group of the German Society of Urology and with the Pediatric Urology Working Society in the Germany Society of Pediatric Surgery. Der Urologe. Ausg. A. 2001;40:495.
Kandasami SV, Mamoulakis C, El-Nahas AR, et al. Impact of case volume on outcomes of ureteroscopy for ureteral stones: the clinical research office of the endourological society ureteroscopy global study. Eur Urol. 2014;66:1046-51.
Lee WJ, Patel U, Patel S, Pillari GP. Emergency percutaneous nephrostomy: results and complications. J Vasc Interv Radiol. 1994;5:135-9.
Avritscher R, Madoff DC, Ramirez PT, et al. Fistulas of the lower urinary tract: percutaneous approaches for the management of a difficult clinical entity. Radiographics. 2004;24:S217-S36.
Kanou T, Fujiyama C, Nishimura K, Tokuda Y, Uozumi J, Masaki Z. Management of extrinsic malignant ureteral obstruction with urinary diversion. Int J Urol. 2007;14:689-92.
Nariculam J, Murphy D, Jenner C, et al. Nephrostomy insertion for patients with bilateral ureteric obstruction caused by prostate cancer. The British journal of radiology. 2009;82:571-6.
Kwon SY, Choi JY, Kim BS, Kim HT, Yoo ES, Park YK. Efficacy of percutaneous nephrostomy tube during ureteroscopy for upper ureter stone management. J Endourol. 2013;27:1209-12.
Kwon SY, Kim BS, Kim HT, Park YK. Efficacy of percutaneous nephrostomy during flexible ureteroscopy for renal stone management. Korean journal of urology. 2013;54:689-92.
Lynch MF, Anson KM, Patel U. Current opinion amongst radiologists and urologists in the UK on percutaneous nephrostomy and ureteric stent insertion for acute renal unobstruction: Results of a postal survey. BJU Int. 2006;98:1143-4.
Mokhmalji H, Braun PM, Portillo FJM, Siegsmund M, Alken P, KÖhrmann KU. Percutaneous nephrostomy versus ureteral stents for diversion of hydronephrosis caused by stones: a prospective, randomized clinical trial. J. urol. 2001;165:1088-92.
Meini S, Santicioli P, Maggi CA. Propagation of impulses in the guinea-pig ureter and its blockade by calcitonin gene-related peptide (CGRP). Naunyn-Schmiedeberg's archives of pharmacology. 1995;351:79-86.
Lennon G, Thornhill J, Grainger R, McDermott T, Butler M. Double pigtail ureteric stent versus percutaneous nephrostomy: effects on stone transit and ureteric motility. Eur Urol. 1997;31:24-9.