<p>Percutaneous nephrostomy (PCN) is a well-established intervention performed to divert urine from the collecting system in ureteric obstruction or as a prelude to interventional procedures such as stent placement or percutaneous nephrolithotripsy (PCNL). The aim of this thesis is to enhance planning for an optimal insertion of PCN, investigate complications, long-term management, follow-up and outcome in patients with PCN treatment and to increase accuracy in CT-guided punctures.</p><p>To enhance planning for an optimal insertion of PCN prior to PCNL, biomodels from CT data were performed. Eight patients with complex urinary calculi were selected. Multislice CT of the kidney was performed and the CT data were transformed into a biomodel. The biomodels visualised unique structures before surgery, which aided the planning of endourological procedures.</p><p>PCNL is an essential procedure for treating complex urinary calculi. A subcostal approach is preferred to avoid laceration to the lung and pleura. However, a supracostal approach is often preferable, as it gives a better passage to the renal pelvis. The nature and frequency of complications after supra- versus subcostal punctures were studied in 85 patients treated with PCNL. In 63 patients, a subcostal track was established. In 22, a supracostal puncture was chosen. The main difference in preoperative complications was the higher number of patients in the supracostal group complaining of respiratory correlated pain (32%). In the subcostal group, this was (5%). </p><p>401 patients were reviewed retrospectively regarding underlying disease, subsequent management and complications of PCN treatment. The number of major complications was 4%. Minor complications were recorded in 38%, urinary tract infection being the most common. 151/401patients suffered from malignancy. 84/151 of the malignant patients died with the catheter. The median survival time of the patients with malignancies was 255 days and the median catheterisation time was 62 days. </p><p>In order to increase accuracy when performing CT guided punctures, a new puncture guide was evaluated. In 15/17 patients the puncture was successful on the first attempt. The benefits of the puncture guide were the artefact from the needle guide pointing at the target indicating the puncture path and the needle support enhancing an accurate puncture.</p>

Percutaneous nephrostomy (PCN) is a well-established intervention performed to divert urine from the collecting system in ureteric obstruction or as a prelude to interventional procedures such as stent placement or percutaneous nephrolithotripsy (PCNL). The aim of this thesis is to enhance planning for an optimal insertion of PCN, investigate complications, long-term management, follow-up and outcome in patients with PCN treatment and to increase accuracy in CT-guided punctures. To enhance planning for an optimal insertion of PCN prior to PCNL, biomodels from CT data were performed. Eight patients with complex urinary calculi were selected. Multislice CT of the kidney was performed and the CT data were transformed into a biomodel. The biomodels visualised unique structures before surgery, which aided the planning of endourological procedures. PCNL is an essential procedure for treating complex urinary calculi. A subcostal approach is preferred to avoid laceration to the lung and pleura. However, a supracostal approach is often preferable, as it gives a better passage to the renal pelvis. The nature and frequency of complications after supra- versus subcostal punctures were studied in 85 patients treated with PCNL. In 63 patients, a subcostal track was established. In 22, a supracostal puncture was chosen. The main difference in preoperative complications was the higher number of patients in the supracostal group complaining of respiratory correlated pain (32%). In the subcostal group, this was (5%). 401 patients were reviewed retrospectively regarding underlying disease, subsequent management and complications of PCN treatment. The number of major complications was 4%. Minor complications were recorded in 38%, urinary tract infection being the most common. 151/401patients suffered from malignancy. 84/151 of the malignant patients died with the catheter. The median survival time of the patients with malignancies was 255 days and the median catheterisation time was 62 days. In order to increase accuracy when performing CT guided punctures, a new puncture guide was evaluated. In 15/17 patients the puncture was successful on the first attempt. The benefits of the puncture guide were the artefact from the needle guide pointing at the target indicating the puncture path and the needle support enhancing an accurate puncture.

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No. of bitstreams: 1 andrenoronhaarvellos.pdf: 6808287 bytes, checksum: 93e22153b8dde05493e1fda7161ac573 (MD5) Previous issue date: 2011-08-26 / Introdução: Impulsionada pelo crescimento da endourologia, a busca de novas técnicas para o acesso percutâneo, com intuito de tornar o procedimento ainda menos invasivo e mais seguro, teve como marco os trabalhos de Valdivia Uría, que propôs e descreveu primeiramente a técnica de punção do paciente em decúbito dorsal inclinado, mostrando menor tempo de procedimento e melhora nos parâmetros cardiorrespiratórios durante sua realização em relação à técnica clássica em decúbito ventral, com sucesso terapêutico e morbidade semelhantes. Mesmo após mais de 20 anos da descrição da sua técnica e com a publicação de outras séries de casos por outros autores, a mesma não teve a difusão esperada. Pacientes e métodos: Foi realizada análise de exames de tomografia computadorizada de 71 pacientes através de simulações de nefrostomia percutânea nos decúbitos dorsal e ventral, correlacionando-se os resultados com variáveis antropométricas e quantificação da gordura abdominal no seu padrão de distribuição nos compartimentos visceral e subcutâneo. Resultados: Não houve diferença estatística entre o número de lesões de órgãos abdominais para os diferentes decúbitos nas simulações realizadas no plano axial (p=0,5621). Nas simulações oblíquas, os resultados mostraram significância estatística da diferença do decúbito no risco de lesão, sendo o resultado desfavorável ao decúbito ventral (p=0,0295). O órgão mais freqüentemente sob risco foi o cólon, seguido de longe pelo intestino delgado. A avaliação indireta do risco de lesão através de medidas da distância do cólon ao rim mostrou maior proximidade destes na posição de decúbito ventral, para ambos os lados, de forma estatisticamente significativa. Quanto à metodologia de análise, observou-se maior número de lesões nas simulações realizadas no plano axial do que nas simulações oblíquas tanto no decúbito ventral (p= 0,0274) como no dorsal (p= 0,0002). Nas simulações no plano axial, os pacientes que tiveram órgãos lesados mostraram de forma estatisticamente significativa menores peso, índice de massa corpórea (IMC) e quantidade de gordura visceral independente do decúbito. No plano oblíquo, não foi observada associação estatística com tais variáveis. Conclusão: Houve maior risco de lesão de órgãos abdominais (principalmente o cólon) no decúbito ventral, tanto através das simulações de punção, quanto através da análise indireta de risco através das medidas de proximidade do cólon com o rim. A metodologia com as simulações no plano oblíquo mostrou-se mais adequada, com resultados mais próximos das grandes séries de casos onde o procedimento foi realizado. Em relação aos dados antropométricos e padrão de distribuição da gordura abdominal por tomografia computadorizada (TC), os pacientes que tiveram órgãos lesados apresentaram de forma estatisticamente significativa menores peso, IMC e área de gordura visceral nas simulações no plano axial, para a análise conjunta das metodologias em ambos os decúbitos e para a análise conjunta da ocorrência independente da metodologia ou do decúbito. Na metodologia de análise no plano oblíquo, os baixos valores de p para as variáveis peso (0,07) e IMC (0,06) podem representar uma tendência em relação ao risco de lesão, talvez com significância estatística limitada pelo tamanho da amostra. / Introduction: The search for less invasive and safer techniques of percutaneous access in endourology had, as landmark, the studies undergone by Valdivia Uria, who first proposed and described access through the inclined supine position, with shortened procedure time and better cardiorespiratory parameters, compared with the traditional access in the prone position, and also showing similar success and morbidity rates. Although more than 20 years have elapsed since the first publication of the technique, and despite publications by other authors, the technique has not been so widely embraced as expected. Patients and methods: 71 patients underwent simulated percutaneous nephrostomy through computed tomography (CT), in both the supine and prone positions. The results were correlated with anthropometric variables and quantification of abdominal fat distribution in the visceral and subcutaneous compartments. Results: There was no statistical difference between the number of abdominal organ injuries in the two different positions in the axial plane (p=0.5621). In oblique simulations, the difference in the risk of injury to abdominal organs was statistically significant between the two positions, with more injuries happening in the prone position (p=0.0295). The colon was the most frequently injured organ, followed by the small intestine in a distant second. Indirect injury risk assessment by measurement of the colon-kidney distance showed statistically significant greater proximity of these organs in the the prone position, on both sides. Concerning the analysis methodology, there were a greater number of injuries in the axial plane than in the oblique simulations, both in the prone position (p=0.0274) and in the supine position (p=0.0002). In the axial plane simulations, patients who suffered organ injuries had statistically significant lower weight, Body Mass Index (BMI) and visceral fat amount, regardless of the position. In the oblique plane, no such statistical association was found. Conclusion: There was greater risk of injury to abdominal organs (mainly the colon) in the prone position, both in puncture simulations and in indirect risk assessment of risk through the measurement of the colon-kidney distance. Simulation in the oblique plane was the most adequate method, as it provided results that were closer to the ones from large case series in which the procedure was performed. Concerning the anthropometric factors and the pattern of CT-assessed abdominal fat distribution, patients who suffered organ injuries had statistically significant lower weight, BMI and visceral fat amount, in the axial plane, for analysis of the two methods in both positions and for analysis of the injuries regardless of method and position. In the oblique plane analysis methodology the low p values for weight (0.07) and BMI (0.06) may represent a tendency towards the injury risk, maybe with a limited statistical significance owing to the sample size.

Perkutan nefrostomi är en väl använd och utarbetat intervention som används som behandling av flera urologiska tillstånd. 10% av alla patienter med perkutan nefrostomi kommer att få en komplikation. Röntgensjuksköterskan ska ha kunskap om de komplikationer som uppkommer för att kunna arbeta förebyggande. Syfte: Syftet med denna litteraturöversikt var att undersöka vilka komplikationer som drabbar patienter med perkutan nefrostomi, hur allvarliga komplikationerna var och orsaken till att de uppkommer. Metod: En allmän litteraturöversikt baserad på 10 kvantitativa vetenskapliga artiklar funna genom artikelsökning i databaserna PubMed och Cinahl. Artiklarna kvalitetsgranskades och analyserades för att sedan presenteras i resultatet under tre huvudkategorier. Resultat: Patienterna drabbades av komplikationer som sepsis, urinvägsinfektion, retroperitonealt hematom, hematuri och komplikationer med nefrostomikatetern. Komplikationerna kunde leda till vidare sjukhusvistelse, utökad behandlingstid med perkutan nefrostomi och vidare ingrepp för korrigering av komplikationen. Sepsis var en bidragande faktor i de dödsfall som var noterade. Slutsats: Kunskapen om komplikationer är betydelsefull i det arbete som röntgensjuksköterskan utför för att kunna agera när de uppstår och arbeta förbyggande. / Percutaneous nephrostomy is a well used and completed intervention used as treatment for many urological conditions. 10% of all patients with percutaneous nephrostomy will get a complication. The radiographer must have knowledge of the complications that occur in order to work preventively. Aim: The aim of this literature review was to examine what kind of complications affect patients with percutaneous nephrostomy, how serious the complications were and causes to the complications. Method: A literature review based on 10 quantitative scientific articles that was found in databases Pubmed and Cinahl. The articles had been quality reviewed and analyzed and was presented under three main categories. Results: The patients suffered from complications as sepsis, urinary tract infection, retroperietal hematoma, hematuria and complications with the nephrostomy catheter. The complications could lead to hospitalization, extended time of treatment with the nephrostomy catheter and more invasive correction for the complication. Sepsis was a contributing factor to the cases with a deadly outcome.  Conclusion: The knowledge of the complications is an important part in the work as a radiographer in order to act when they occur and work preventively.