Incidence and implications of silent hydronephrosis following percutaneous nephrolithotomy
| Autor: | Lawrence M. Dagrosa, Rachel A. Moses, Vernon M. Pais |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Ureteral Calculi medicine.medical_treatment Urinary system Population 030232 urology & nephrology Hydronephrosis Asymptomatic 03 medical and health sciences Postoperative Complications 0302 clinical medicine Ureteroscopy medicine Humans Percutaneous nephrolithotomy education Aged Nephrostomy Percutaneous Retrospective Studies Ultrasonography education.field_of_study medicine.diagnostic_test business.industry General Medicine Middle Aged medicine.disease Surgery Nephrology Asymptomatic Diseases Nephrostomy Female Ureteral Stricture medicine.symptom business Ureteral Obstruction |
| Zdroj: | Clinical Nephrology. 87:29-32 |
| ISSN: | 0301-0430 |
| Popis: | Objective While routine renal imaging following ureteroscopy for urinary calculi has been recommended to screen for asymptomatic "silent" obstruction, the rate of silent obstruction following percutaneous nephrolithotomy (PCNL) remains poorly defined, and no consensus recommendations exist on routine postoperative imaging. At our institution, we sought to assess the incidence of silent hydronephrosis (SH), as a screen for obstruction, following PCNL. Methods The records of all 162 patients who met study inclusion criteria were reviewed. Of this group, 112 patients presented for their scheduled renal ultrasonography 4 - 6 weeks following stent removal to screen for SH. Asymptomatic patients found to have ultrasonographic evidence of hydronephrosis were further analyzed. Results SH was noted in 16% (18/112) of patients. Two required subsequent ureteroscopic stone extraction (1.8%), one of which also underwent endoureterotomy for a ureteral stricture. Four patients (22%) had stable hydronephrosis and declined functional imaging, 2 patients (11%) had a known partial ureteropelvic junction obstruction and declined intervention. SH resolved spontaneously in 50% (9/18) with a mean time to resolution of 6.3 months. There was no difference in stone complexity based on Guy's stone score between groups, 2.8 (± 0.92) vs. 2.4 (± 1.03), p = 0.34. Although not statistically significant, patients with SH were more likely to have had residual stone fragments postoperatively, 39% (7/18) vs. 19% (18/94), p = 0.067. Conclusions SH following, PCNL was identified in 16% of this screened population, with the majority requiring no intervention. However, SH may be attributed to residual stone or stricture, which may have been otherwise unrecognized in up to 2% of patients undergoing PCNL. Consideration should be given for routine postoperative ultrasound to screen for silent obstruction following PCNL. . |
| Databáze: | OpenAIRE |
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