INDICATIONS AND MORBIDITY OF PERCUTANEOUS NEPHROSTOMY; EXPERIENCE FROM A TERTIARY CARE UROLOGY SERVICE

ABSTRACT
Background: Indications for percutaneous nephrostomy (PCN) in emergency and in elective situations is commonly
to relieve obstruction or to divert urine flow distally. No consensus exist for its indications.
Objectives: The aim of this study was to determine the indications and postoperative morbidity of patients who undergo
PCN for various reasons in terms of overall survival and metabolic restoration.
Methods: This is a prospective study of 117 patients who underwent PCN for various indications during a 12-month
period (January 2016 to December 2016) at the department of urology MTI, LRH. We recorded data for patient demographics,
primary diagnosis, metabolic profiles, overall survival and postoperative complications. The data was analysed
for the impact on survival with regard to indications and postoperative morbidity.
Results: 117 patients, with 72 (61.5%) males and 45 (38.5%) females, with a mean age of 48.6 ± 15.5 years (range: 18-77
years). mean blood urea nitrogen (BUN) of 66.5 ± 14.8 and mean creatinine was 8.6 ± 2.6 mg/dL. Thirty-nine (33.3%)
patients underwent dialysis before PCN.There were 18 (15.4%) emergency PCNs and 99 (84.6%) cases were elective.
The most common malignancy was Ca bladder with 27 (23.1%) &second most common malignancy was Ca prostate
with 20 (17.1%) cases. Mean LOS was 14.9 ± 3.3 days andthe most common complication was tube dislodgement
(n = 11, 9.4%) at a mean postoperative day 26.3 ± 6. UTI occurred in 11 (9.4%) cases at an average of postoperative
day 15, while haematuria occurred in 15 (12.8%) cases with the requirement of transfusion in four (3.4%). On paired
samples t-test a mean difference of 48.5 ± 17.3 mg/dL was observed between the preoperative and postoperative BUN
at postop day 7 (95% CI: 45.3 to 51.6, p<0.0001).
Conclusion: PCN is a safe and effective procedure. It rapidly reverses the metabolic derangements associated with
uraemia. Most common complications are minor, such tube dislodgement and urinary tract infection. Major complications
such as haematuria, haemorrhage, and sepsis are less frequent and managed with admission of the patient,