Allison Starr Aguado MD, Presenter: Nothing to Disclose

Matthew Christman MD, Abstract Co-Author: Nothing to Disclose

Marc Sheldon Keller MD, Abstract Co-Author: Stockholder, General Electric Company Stockholder, Johnson & Johnson Stockholder, Laboratory Corporation of America Holdings Stockholder, Pfizer Inc Stockholder, UnitedHealth Group Stockholder, Endo Pharmaceuticals Holdings Inc Stockholder, GlaxoSmithKline plc Stockholder, Stericycle, Inc Stockholder, Teva Pharmaceutical Industries Ltd Stockholder, Cardinal Health, Inc Stockholder, CVS Caremark Corporation Stockholder, Schering-Plough Corporation

Ganesh Krishnamurthy MD, Abstract Co-Author: Nothing to Disclose

Els L.F. Nijs MD, Abstract Co-Author: Nothing to Disclose

Anne Marie Cahill MBBCh, Abstract Co-Author: Nothing to Disclose

To describe a single institution’s experience with pediatric percutaneous nephrostomy tube placement.

This is a retrospective IRB approved study which analyzed 83 nephrostomy procedures performed on 65 children over a 6 yr period. Retrospective chart review was performed for indications, techniques, outcomes, and complications. Indications included calculus (31/83), UPJ obstruction (18/83), ureteral stricture (12/83), obstructive pyelonephritis (7/83), pelvic mass (4/83), UPJ with recurrent stenosis (3/83), postsurgical obstruction (3/83), posterior urethral valves (2/83), congenital UVJ obstruction (2/83), and obstructed dysplastic kidney (1/83). The average age of the patient group was 10.8 yrs (range 1d-48yrs). 29% of the procedures (24/83) were performed on patients less than 6 months old.  

81/83 (98%) procedures were successful. 2/83 procedures failed due to extensive calculi. Nephrostomy tubes were placed as follows; right 24, left 35, bilateral 7, and 8 in transplant kidneys using US guidance in 80/81 procedures. The catheters placed included: 6F Dawson Mueller (25/81), 7F Dawson Mueller (16/81), 8.5F Dawson Mueller (13/81), 8.5F MPD (4/81), 10.2F MPD (1/81), 5F NU (1/81), and 8.5F NU (21/81). There were no immediate post-procedure complications or infections. 1/81catheters was dislodged 16 days post placement. One catheter was removed in the OR for an abnormal course. 18/83 catheters underwent catheter exchanges, 5 in IR and 13 in the OR. The indications for IR exchanges were peri-catheter leakage (4/5) and elective exchange pre discharge (1/5). OR exchanges were performed for related therapeutic procedures in (12/13) and repositioning (1/13). Catheter removal data was available for 77/81 catheters. Two patients were lost to follow-up, and 2 transferred care to other facilities. The average indwelling time of nephrostomy catheters was 40.1days (range 1-189d).  

This will be the largest study to date describing pediatric percutaneous nephrostomy tube placement.

In our experience, percutaneous nephrostomy is technically feasible with high success rates and low complications rates in the pediatric population.

Aguado, A, Christman, M, Keller, M, Krishnamurthy, G, Nijs, E, Cahill, A, Pediatric Percutaneous Nephrostomy: A Single Institutional 6-year Retrospective Experience.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11015461.html