Percutaneous Nephrostomy in Infants and Children

Son, Hwancheol; Kim, Kwang Myung; Choi, Hwang

Abstract

Percutaneous nephrostomy (PCN) is an established technique in urology but there have been few reports in pediatric urology. We reviewed retrospectively 48 cases for evaluation of the indication, results, complications, and the methods of follow-up after PCN. From October '85 to December '95, on 50 kidneys of 48 patients, 64 PCN were performed. Male patients were predominant (39:9). The indication of PCN were the functional evaluation of huge hydronephrotic kidneys (23 PCN), the relieve of urinary obstruction (10), the urinary diversion (9), the urinary tract infection (11), the differential diagnosis of hydronephrosis (1) and re-PCN after catheter displacement or obstruction (10). 23 patients for the functional evaluation of huge hydronephrotic kidneys that had poor function in the intravenous pyelography or the radioisotope renal scan, and/or the thin parenchyme in ultrasound, had got the regular follow-up with check of the daily urine output, the creatinine clearance after 2-14 days. 19 who showed good urine output (200-1000ml/day) and good creatinine clearance (average 22.4% of total creatinine clearance) after 2-14 days, were managed by reconstructive surgery and nephrectomy was performed in 4 patients who showed poor urine output (less than 10 ml/ day) or poor creatinine clearance( 1.1 and 3.5 % of total creatinine clearance). After PCN, there were mild infection in 3 cases and no serious complication. But there were catheter displacement in 13 cases and catheter obstruction in 3 cases, and in 13 cases of catheter displacement, 8 (53.3%, 8/15) were under 1 year-old, 4 (25%, 4/16) were between 1 and 5 year-old, and 1 (5.9%, 1/17) was over 6 year-old. In 2 cases of UPJ obstruction, the thickening of renal pelvis had made pyeloplasty difficult. Our data shows that a brief period (within 2 weeks) of nephrostomy drainage allows the kidney to display its potential for recovery of function, as measured by differential creatinine clearance and daily urine output. In pediatrics, PCN should be performed carefully in the selected cases and the duration of nephrostomy should be shortened as possible.