PERCUTANEOUS NEPHROSTOMY FOR RELIEF OBSTRUCTIVE UROPATHY: BENIGN VERSUS MALIGNANT DISEASE
Abstract: This study aimed to
find out the effectiveness of percutaneous nephrostomy (PCN) as palliative
decompression of the obstructed urinary system. Materials & Methods: A case
control study was performed with 118 patients (69 female and 49 male) with
obstructive uropathy who were undergoing PCN during 2009 until 2012,
retrospectively. The mean of age was 50.03 years. The PCN technique involves an
ultrasound-guided puncture of the dilated collecting system with nephrostomy
trocar than insert an 8 Fr nasogastric tube as nephrostomy catheter.
Differences of renal function between benign and malignancy were assessed using
Independent t-test. Changes in renal function after procedure were expressed as
mean ± SD and analyzed using Pair t-test.
Results: There was no procedure-related mortality. The most cause of
malignancy was cervix cancer (36.4%) while the result of a benign process was
28.8% of urinary tract stones. Dialysis before procedure were performed in 43
(36.4%) consisting of 42 malignancies and 1 benign process. Improvement in
renal function were statistically significant both benign and malignant groups
seen in the levels of creatinine and blood urea nitrogen (BUN) before and after
procedure (p<0.001). The mean differences were also statistically
significant at the preoperative creatinine values between benign and malignant
processes (p=0.019) but BUN levels before and after as well as postoperative
creatinine levels showed no significant difference. Conclusion: PCN is a widely
used technique, with a high technical success rate and low rate of
complications. Obstructive uropathy due to benign processes had a better
prognosis than malignancy after PCN treatment. Hemodialysis was mainly
performed in patients with malignancy prior to PCN.
Keywords: Percutaneous
nephrostomy; obstructive uropathy; benign; malignancy
Author: Prahara Yuri, Sungsang
Rochadi
Journal Code: jpkedokterangg170008