Tariq Mahmood, Raza Younus, Fayyaz Ahmad, Shakoor Memon, Ameer Moavia.
Ultrasound as a reliable guidance system for Percutaneous Nephrostomy.
J Coll Physicians Surg Pak Jan ;17(1):15-8.

Objective: To determine the effectiveness and safety of ultrasound as a reliable guidance system for percutaneous nephrostomy (PCN). Study Design: Quasi-experimental. Place and Duration of Study: Jinnah Postgraduate Medical Center, Karachi, Pakistan, from January 1997 to July 2005. Patients and Methods: One hundred and fifty-three PCN were performed in 140 patients, referred from the Department of Urology and Transplantation, JPMC. Out of 140 patients, 137 had obstructive uropathy (>1 cm dilated pelvicalyceal system) of different etiologies. Three patients with ureteral rupture (non dilated pelvicalyceal system) underwent PCN for urinary diversion in the surgical ICU. The technique involved a pre procedural scan, initial renal puncture, placement of a guide wire, tract dilation and placement of 8-12 F Nephrostomy tube, entirely under ultrasound guidance. The machine used was `Just vision` or `Eccocee` with 3.5 MHz variable frequency convex transducer. Effectiveness in terms of successful tube placement and safety in terms of complications were observed. Results: Out of 153 patients there were 78 males and 62 females. The minimum age of patient was 13 years while maximum age was 68 years, all (100%) patients had successful placement of PCN. Minor complications like transient gross hematuria and small perinephric collection occurred in 13 cases (8.5%) but was dealt with effectively by conservative measures. No major complications like hemorrhage, sepsis or periorgan damage were encountered in any of the patients. Conclusion: Ultrasound was found to be a rapid, effective, radiation-free, portable and safe imaging modality with minimum rate of complications that could be used as a reliable guidance system for critical interventions like percutaneous nephrostomies without using fluoroscopic units.

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