Methylene Blue Injection as an Alternative to Antegrade Nephrostography to Assess Urinary Obstruction After Percutaneous Nephrolithotomy
| Autor: | Molly Elmer-Dewitt, Bogdana Schmidt, Marco Sandri, Marshall L. Stoller, Thomas Chi, Ian Metzler, Matthew D. Truesdale, Adam J. Gadzinski |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
Radiography Abdominal medicine.medical_specialty Percutaneous Urology medicine.medical_treatment Clinical Sciences 030232 urology & nephrology Nephrostomy tube General Research Sensitivity and Specificity Injections 03 medical and health sciences 0302 clinical medicine medicine Effective treatment Humans Abdominal Postoperative Period Percutaneous nephrolithotomy Nephrostomy Percutaneous Nephrostomy Methylene blue Injection business.industry Nephrostography Urology & Nephrology Middle Aged Surgery Radiography Methylene Blue Urinary obstruction 030220 oncology & carcinogenesis Fluoroscopy Injections Intravenous Female Urinary Calculi Intravenous business |
| Zdroj: | Truesdale, MD; Elmer-Dewitt, M; Sandri, M; Schmidt, B; Metzler, I; Gadzinski, A; et al.(2016). Methylene Blue Injection as an Alternative to Antegrade Nephrostography to Assess Urinary Obstruction After Percutaneous Nephrolithotomy. JOURNAL OF ENDOUROLOGY, 30(4), 476-482. doi: 10.1089/end.2015.0594. UC San Francisco: Retrieved from: http://www.escholarship.org/uc/item/2723k53s Europe PubMed Central Journal of endourology, vol 30, iss 4 |
| DOI: | 10.1089/end.2015.0594. |
| Popis: | Aims and objectivesPercutaneous nephrolithotomy (PCNL) remains an effective treatment for large stones. When nephrostomy tube (NT) is left post operation, antegrade urine flow is often confirmed with antegrade nephrostography (ANG) before tube removal. We compare methylene blue (MB) test combined with NT capping trial against ANG to assess antegrade urine flow after PCNL.Materials and methodsOne hundred one consecutive patients undergoing PCNL were prospectively enrolled between 7/2014 and 4/2015. An NT cap was placed the morning of postoperative day 1 (POD1). Failure was defined as need to uncap the NT for any reason. Two hours after capping, 7cc MB was injected into the NT. Positive MB test was defined as presence of blue per bladder Foley. ANG was then performed to assess antegrade urine flow. NTs were removed before discharge home when antegrade flow was documented. Primary outcomes included presence of antegrade flow on ANG and NT removal before discharge home. Receiver operating characteristic (ROC) and areas (Area under the ROC [AUC]), as well as Cohen's kappa coefficient (κ), were calculated comparing agreement of capping trial, MB, and ANG with NT removal.ResultsOne hundred one subjects were included in this analysis. 52.9% were left-sided surgeries and 60.4% utilized lower pole punctures. On ROC areas evaluating tests for agreement with NT removal before discharge, MB AUC 0.71 (95% CI 0.60-0.83), capping trial AUC 0.66 (95% CI 0.57-0.75), combed capping trial and MB AUC 0.72 (95% CI 0.61-0.84), and ANG AUC 0.78 (95% CI 0.68-0.88). In predicting NT removal, ANG performed better than capping trial alone (p = 0.042), but no differences were seen between MB and ANG (p = 0.229), combining the capping trial with MB test and ANG (p = 0.266) or combined testing and MB alone (p = 0.972).ConclusionsCombining capping trial with MB injection is similarly accurate for predicting NT removal after PCNL compared to ANG. Capping trial and MB may be used in combination to obviate the need for ANG. |
| Databáze: | OpenAIRE |
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