Monday, May 17, 2010

Percutaneous Nephrostomy:Life saving measure in obstructed kidneys

A 50 year old lady came to us with history having tretaed for Carcinoma Cervix stage 3 B.She had recieved 4 fractions of EBRT outside.

She had history of pain in right flank and fever since 2 days.Her investigation revealed anemia,polymorphonucelocystosis,raised creatinine 11.4mg%

She was taken up for emergency PCN(percutanoeus nephrostomy).

The both pelvicalyceal systems were punctured with 20 G cheeba needle with ultrasound guidance.Then dyestudy was performed.
After the pelvicalyceal delineation,both the systems were punctured with 18 G PCN needle in posterio-inferior calyx.The guidewire was then placed and the tract was subsequently dilated till 16 fr.At the end of the procedure 14 Fr Malecots was placed in both systems.

There was hydronephrotic drip on both sides.She is supplemented with fluids and strict watch has been kept on her Electrolytes and ABG parameters to prevent post-obstructive diuresis and its complications.

Once the creatinine comes up she will be fit for stenting as the kink in ureter due to malignancy will disappear and she will be a good candidate for chemotherapy.

The facilities for emergency PCN are necessary at every Hospital and all the urologists should be well trained for the same as it can obviate the need for hemodialysis in such situations.It can be life saving measure and does not take more than 30 minutes.

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