Pediatrik Hastalarda Görüntüleme Eşliğinde Perkütan Nefrostomi
Özet
The aim of this study was to evaluate the safety and efficacy of percutaneous nephrostomy in ultrasonography (US) and fluoroscopy guidance in the pediatric age group. Patients in the pediatric age group who underwent percutaneous nephrostomy between May 1993 and December 2015 in our clinic were scanned retrospectively from the hospital electronic information system and physical files. In our study, nephrostomy was performed in 231 patients, total 270 kidneys. The mean age of participants was 66,07 ± 62,10 months (median age: 48 months, minimum 1 day, maximum 216 months). 204 patients (88,3%) were treated with 18-19G needle (Seldinger technique) and 27 patients (11,7%) were treated with 21G needle (Accustic technique). In the Seldinger technique, 18G needle was used in 79 patients (38,7%) and 19G needle was used in 125 patients(61,3%). Before the procedure, the patients were given appropriate prophylactic antibiotics. All procedures were performed under standard sterile conditions, while the patient was in the pron position, under US guidance and under fluoroscopy. Lower or middle calyx access was provided. After appropriate positioning of the catheter, the skin was fixed with the seam and after the procedure the patients were observed for 6-8 hours in the observation room. The most frequent indication for nephrostomy was ureteropelvik junction obstruction (n = 72, 31,4%). No technical failure was present in any patient. There was no mortality. There were major complications in 4 patients (1,6%). Methemoglobinemia and respiratory arrest due to local anesthetic in 1 patient, urinoma due to extravasation of urine in 3 patients. Minor complications were present in 4 patients (1,6%). Three patients had perirenal hematoma that did not require transfusion and 1 patient had urinary extravasation that did not require drainage and spontaneously regressed on follow-up. The problems related to the catheter, requiring replacement or revision, were detected in 25 patients (10,8%). In 12 patients a nephrostomy catheter came out and was replaced in the same way. 13 patients were changed or revised for various reasons. The mean day of catheterization in our patients was 28.72 ± 45.82 (minimum 2 - maximum 345). The longest stay of catheter was due to tumoral causes followed by iatrogenic causes and vesicoureteral reflux. All catheters were removed after appropriate treatment of the underlying disease. There was a statistically significant difference between the creatinine and blood urine nitrogen (BUN) values before and after nephrostomy (p <0.001, p <0.001, respectively). When the subgroups according to the etiology were examined, it was found that this fall belonged to the patient with ureteropelvik junction obstruction and tumor associated obstruction (p = 0.001, p <0.001 respectively). In conclusion, percutaneous nephrostomy performed in imaging guideline in pediatric patient group is safe and effective method with high success rate and low complication risk.
