Percutaneous nephrostomy of nondilated renal collecting systems with fluoroscopic guidance: Technique and results

PURPOSE: To retrospectively review experience with a double-puncture technique for percutaneous nephrostomy of nondilated renal collecting systems. MATERIALS AND METHODS: Over a 5-year period, 15 patients (26 kidneys) without calyceal dilatation at ultrasonography (US) who required nephrostomy drainage were studied. Eleven patients (21 kidneys) had ureteral leaks or fistulas, one patient (one kidney) had a renal pelvic stone, one patient (one kidney) was suspected of having a ureteral tumor, and the final two patients (three kidneys) had acute nondilated renal failure. Mean age was 62 years (range, 20-78 years); 13 patients were men and two were women. A double-puncture technique was used with fluoroscopic guidance (supplemented with US in some patients who had renal failure). After intravenous administration of iodinated contrast material, a 22-gauge needle was inserted into the opacified renal pelvis, and double-contrast pyelography was performed by using air or carbon dioxide to allow visualization and distention of the nondependent calyces for definitive renal access with an 18-gauge 5-F sheath-needle set and a hydrophilic wire. After serial dilation, a nephrostomy or nephroureteral catheter was inserted. Success and major complication rates were studied by reviewing radiologic and clinical case notes. RESULTS: Catheter placement was successful in 25 (96%) of 26 kidneys after one, two, or three passes with the sheath-needle set. In all successful cases, the calyx was accurately punctured. There we re two major complications. One patient developed hernaturia that required transfusion but no further intervention; another sustained a renal pelvic injury, but this was believed to be due to excessive dilation of the pelviureteral junction, not faulty renal puncture. There were no cases of septicemia. CONCLUSION: With a double-puncture technique and air or carbon dioxide distention, nephrostomy was achieved in 25 (96%) of all nondilated renal collecting systems. There were two major complications (two [8%] of 25 kidneys, two [13%] of 15 patients, but only one was secondary to the renal puncture. (C) RSNA, 2004.