Percutaneous Nephrostomy: Is Ultrasound Alone Sufficient as Imaging Guidance?

Percutaneous nephrostomy (PN) is a frequently performed invasive procedure for the maintenance of renal function in cases of urinary obstruction. Transient hemorrhage is a common minor complication of this procedure. The aim of this study was to determine which of the selected methods was less traumatic in two groups of PN patients guided by two different radiological modalities. A total of 64 PN procedures performed in 2018, with an equal number of two different approaches (ultrasound-guidance, ultrasound and fluoroscopy-guidance) to PN were compared to determine which method was less traumatic. Urine samples were taken from the collecting system after needle insertion and after catheter placement, and the amount of blood in the urine samples was recorded to assess hematuria. In addition, after fluoroscopy-guided procedures, the radiation exposure time, air kerma and kerma-area-product values were recorded and compared with data in the literature. Although the average amounts of blood detected in the urine samples taken at two stages of two different methods differed, these differences were not statistically significant. There was a statistically significant positive correlation between the amount of the blood in the urine samples taken after the needle insertion and kidney parenchymal thickness (p=0.013). To protect patients and interventional radiologists from unnecessary radiation exposure, PN with ultrasound only guidance may be a good choice for selected cases, such as those with evident pelvicalyceal dilatation, pediatric patients and pregnant women.