PURPOSE: To compare the efficacy of contrast-enhanced and T2-weighted magnetic resonance urography (MRU) for the depiction of obstruction and evaluation of the causes of obstructive uropathy with that of antegrade pyelography. MATERIALS AND METHODS: Twenty-five patients with obstructive uropathy who underwent percutaneous nephrostomy (PCN) and antegrade pyelography (AGP) were included in the study. We performed MR urography, comprising half-Fourier acquisition single-shot turbo spin-echo (HASTE) T2-weighted imaging and 3-D fast imaging with steady state precession (3-D FISP) T1-weighted imaging after gadolinium enhancement and compared the quality of the images of both the HASTE and 3-D FISP MRU techniques in terms of their depiction of the dilated pelvocalyceal system, and the level, type, and causes of obstruction. RESULTS: In terms of anatomical depiction of the pelvocalyceal system (p=0.002) and the causes of obstruction (p=0.003), T1-weighted MRU using 3D-FISP was significantly better than T2-weighted MRU using the HASTE sequence. Regarding level of obstruction, T2-weighted MRU using the HASTE sequence and contrastenhanced T1-weighted MRU using 3D-FISP showed an accuracy of 76% (19/25) and 84% (21/25), respectively. In terms of type of obstruction, the accuracy of T2-weighted MRU and T1-weighted CEMRU was 72%(18/25) and 88% (22/25), respectively. CONCLUSION: T2-weighted MRU and T1-weighted CEMRU provided both anatomical information and that relating to impaired renal function. The two modelities played a complementary role and their use could decrease the unnecessary use of invasive diagnostic examination for the evaluation of obstructive uropathy.
Gadolinium ; Humans ; Nephrostomy, Percutaneous ; Urography*

Of the 443 patients who underwent percutaneous renal surgery at our hospital, 24 patients(5.4% ) required open surgery. We evaluated the causes of open surgery and their operative methods in those patients. The most common cause of open surgery was inadequate puncture(10 patients)into the posterior calyx. The remainders were severe bleeding(5 patients), difficulties in fragmentation (4 patients), embedded stones( 3 patients), downward migration of stone(1 patient) and poor renal function(1 patient). Their operative methods were pyelolithotomy(9 patients),ureterolithotomy(9 patients), nephrolithotomy(1 patient), nephrectomy(3 patients) and partial nephrectomy(2 patients). Two patients who showed delayed bleeding underwent nephrectomy, because bleeding was continued in spite of conservative management or selective angioinfarction. We believe that problems and complications may occur at any point in the percutaneous renal surgery and as with other open surgery, knowledge of what complications may occur and which method is the best way to solve them will assist in their prevention and awareness of how to manage suck complicatioins will minimize their impact.
Hemorrhage ; Humans ; Nephrectomy ; Nephrostomy, Percutaneous

Percutaneous nephrostomy has proved to be a safe and effective procedure to preserve renal function in obstructive uropathy by the development of radiologic technologies and experiences, which is associated with a low rate of significant complications. Bowel perforation is an unusual complication of this technique. We report a case of a nephro-colo-cutaneous fistula following percutaneous nephrostomy in a case of renal tuberculosis.
Fistula* ; Nephrostomy, Percutaneous* ; Tuberculosis, Renal

PURPOSE: To compare the clinical parameters and complications between standard and tubeless percutaneous nephrolithotomies (PCNL). The purpose of this study was to assess the efficacy, safety and morbidity of a tubeless percutaneous nephrolithotomy. MATERIALS AND METHODS: A total of 102 patients, who underwent a PCNL at our institution by one surgeon, were enrolled in this study. Of the 102 patients, 30 underwent a standard PCNL between January 2001 and July 2002, and 72 underwent a tubeless PCNL between July 2002 and March 2005. All the PCNL were performed using a balloon tract dilator and 30Fr. working sheath. In the standard PCNL group, a 12Fr. nephrostomy tube was inserted. In the tubeless PCNL group, no nephrostomy tube was inserted, with the skin sutured onto the site of the nephrostomy. The stone volume, operating time, amount of blood loss, complications and hospital stay were compared between the two groups. RESULTS: There were no significant differences in stone volumes, decrease in postoperative 1 day hemoglobin, transfusion rates and complication rates between the two groups. However, the postoperative hemoglobin (p=0.05) and hospital stay (p=0.001) were significantly less in the tubeless compared to the standard PCNL group. CONCLUSIONS: The tubeless PCNL was associated with no more bleeding or complications than the standard PCNL. Tubeless PCNL is a recommendable procedure in percutaneous renal stone surgery.
Hemorrhage ; Humans ; Length of Stay ; Nephrostomy, Percutaneous* ; Skin

We review 66 patients with lower caliceal stones treated with extracorporeal shock wave lithotipsy. One of the major problems involved with extracorporeal shock wave lithotripsy is the high rate of residual stone fragments in the lower calices. We observed the influence of the presence of lower caliceal dilatation, hydronephrosis, and the size of alone on the passage of stone. Thirty-nine of the 66 patients with a lower caliceal stone and no stone fragments. The success rate was only 59 per cent. The stone was completely fragmented in 59 of 66 (89%) patients. Thirty-nine of 59 patients who had completely fragmented stones. had no residual fragments. The patients who had no lower caliceal dilatation and a relativgly small size stone (less than 1.5 x 1.0 cm). such as in group 4. had a high success rate of 70%. The patients with a large stone or the presence of caliceal dilatation. were expected to low success rate, therefore there was a need for repeated treatment with extracorporeal shock wave lithotripsy and combined treatment with percutaneous nephrostomy.
Dilatation ; Humans ; Hydronephrosis ; Lithotripsy* ; Nephrostomy, Percutaneous ; Shock*

Latrogenic extraperitoneal bowel perforation accounts for 0.8% of potential adverse events of percutaneous nephrolithotomy. Most of perforated cases were detected post-operatively because of non-specific clinical symptoms. Conservative management may be performed in cases of retroperitoneal injuries by using separation technique of colon from involved kidney to prevent the formation of fistula.
Nephrostomy, Percutaneous ; Intestines ; Intestinal Perforation ; Therapeutics

Though high stone free rates were reported with ESWL monotherapy or anatrophic nephrolithotomy, percutaneous nephrolithotomy with or without ESWL appears to be the procedure of choice for most staghorn calculi. A total of 41 patients with staghorn calculi underwent percutaneous nephrolithotomy(PNL) alone or primary percutaneous debulking followed by extracorporeal shock wave lithotripsy(ESWL) of residual stone fragments. For the objective analysis of the results of PNL stone removal rate was calculated with stone surface area which was determined by computer analyzer. For staghorn calculi smaller than 2000 mm2(38/41), a mean stone removal rate of about 90% was achieved in the PNL. When stone surface area exceeded 2000 mm2(3,41), the mean stone removal rate was 78.8%. The stone removal rates stratified by stone surface area were not significantly different. The stone free rate was 31.7% in the PNL only but 75.6% in the PNL with or without ESWL. The higher mean stone removal rate and stone free rate was achieved in the kidneys with non-dilated collecting system than those with hydronephrosis, but it was not statistically significant.
Calculi* ; Humans ; Hydronephrosis ; Kidney ; Nephrostomy, Percutaneous* ; Shock

Percutaneous renal puncture device has very important clinical value. Qualified percutaneous renal puncture device is one of the important ways to evaluate its safety and efficacy, and it is also an important prerequisite for the device to be marketed in China. When manufactuers test the product, the selection of representative products is suggested from the aspects of performance parameter, structure, material and production process.
China ; Humans ; Kidney ; Nephrostomy, Percutaneous ; instrumentation ; Punctures

Humans ; Kidney Calculi ; therapy ; Nephrolithotomy, Percutaneous ; Nephrostomy, Percutaneous

The effects on renal function following percutaneous nephrolithotomy(PNL) were investigated on 37 patients. The overall success rate was 76%. The success rate on renal stone(79% ) was better than on upper ureter stone(67% ). The complication rate was much lower on later cases according to the increasing experiences and improved technique. The renal function was evaluated on 15 cases using DMSA renal scan and separate creatinine clearance rate pre-and post-operatively. Fourteen cases out of fifteen cases showed no significant renal functional change statistically. However, only one case who had massive renal bleeding for eight days postoperatively showed about 18% reduction of renal function and which case was considered due to major renal vascular damage during PCN tract creation. Conclusively, PNL seemed to be safer and has lower morbidity rate than surgical removal of stone if carried out by experienced hands.
Creatinine ; Hand ; Hemorrhage ; Humans ; Nephrostomy, Percutaneous* ; Pregnenolone Carbonitrile ; Succimer ; Ureter