Anterior Tunnelled Percutaneous Nephrostomy – a novel technique for patients requiring a permanent nephrostomy

Authors: G P Naisby, N Vasdev, O Alkoussayer, H Scullion, R Gowda, A West, J Cresswell, G Riley, M Harris , D Chadwick
James Cook University Hospital, Middlesbrough, United Kingdom

Corresponding Author: Dr Geoff Naisby , Consultant Interventional Radiologist, Department of Radiology, James Cook University Hospital, Marton Road, Middlesbrough ,TS4 3BW, United Kingdom

Aim

The ‘Anterior Tunneled Percutaneous Nephrostomy’ (AT-PCN) is a prevailing technique that aims to improve the quality of life in patients with benign or malignant ureteric obstruction, who are otherwise unsuitable for surgical urinary diversion. It is designed to achieve an anterior exit site for the drainage catheter, which we propose will improve patient quality of life by permitting better independence and comfort, while also reducing demand on nursing.

Patients and Methods

The ‘Anterior Tunnelled Percutaneous Nephrostomy’ (AT-PCN) is a novel technique that aims to improve the quality of life in patients with benign or malignant ureteric obstruction, who are otherwise unsuitable for surgical urinary diversion.it is designed to achieve an anterior exit site for the drainage catheter, which we propose will improve patient quality of life by permitting better independence and comfort, while also reducing the demand on nursing time

A prospective review of the case notes was carried out for those patients receiving AT-PCN (March 2007 to Dec 2009). Diagnosis, previous interventions and complications were recorded. We measured procedure time, pain score, immediate and delayed complications, repeat procedures, nephrostomy replacements and patient survival. Patient ‘quality of life scores’ and ‘Karnofsky performance status’ were collected by nurse specialists prior to the procedure and at 1 week, 1 month and subsequently 3-monthly intervals as possible.

Results

A total of 43 procedures were performed from June 2007 until June 2009. Majority of patients present with obstructive uropathy including 5 with sepsis. Seventy three percent of patients had unsuccessful ureteric stenting and required permanent nephrostomies. Intra-procedure pain is scored the same for both AT-PCN and traditional PCN. Patients recorded a significant improvement in independence and ability to self-care, including managing the nephrostomy bag.Patients who had secondary AT-PCN, with experience of traditional posterior exiting nephrostomy, reported significant improvement in quality of life and independence. None of our patients had contact dermatitis around the Nephrostomy site.

Conclusion

In palliative care, the patient’s experience is key. Posterior PCN is commonly required in cases of palliative urinary diversion and can negatively impact on a patient’s QoL. Our study demonstrates AT-PCN can substitute the PCN and offer benefits (independence, comfort, mobility) with no additional procedural burden. The AT-PCN is acceptable to patients, and results in a better quality of life.

Date added to bjui.org: 18/04/2013

DOI: 10.1002/BJUIw-2012-041-web