**6. Role of percutaneous nephrostomy in transplanted kidneys**

The indications for percutaneous nephrostomy described above can be similarly adopted for transplanted kidneys, and indeed percutaneous nephrostomy has been shown to have a good safety profile in these cases (Mostafa, Abbaszadeh et al. 2008). Mostafa further demonstrated that there was no statistical difference in the 10-year survival rates of renal transplant recipients who underwent percutaneous nephrostomy when compared to other renal transplant recipients without urological complications. It also serves as a useful alternative to conventional surgery, which may pose a higher risk in these patients.

Percutaneous nephrostomy has a low mortality rate, with published data reporting rates of 0.03% (Hruby 1990) and 0.3% (Lee, Smith et al. 1987). Various major complications may contribute to death following the procedure, particularly in relation to severe hemorrhage and sepsis, but it may also be contributed by other complications provoked by the procedure itself. Myocardial infarction and cardiac arrest have been reported (von der Recke, Nielsen et al. 1994). Lee reported deaths in 2 patients, one of which was attributed to respiratory failure related to underlying severe interstitial pulmonary fibrosis, while the other was due to myocardial infarction in an obese diabetic patient with hypertension. The presence of comorbidities is therefore an important predisposing factor. Patients who require general anesthesia may also be at risk of developing associated complications. However the mortality rate for percutaneous nephrostomy remains lower than conventional surgery for patients who require urological intervention but are not good candidates for

The indications for percutaneous nephrostomy described above can be similarly adopted for transplanted kidneys, and indeed percutaneous nephrostomy has been shown to have a good safety profile in these cases (Mostafa, Abbaszadeh et al. 2008). Mostafa further demonstrated that there was no statistical difference in the 10-year survival rates of renal transplant recipients who underwent percutaneous nephrostomy when compared to other renal transplant recipients without urological complications. It also serves as a useful

alternative to conventional surgery, which may pose a higher risk in these patients.

Fig. 15. Withdrawal of the PCN into the colon to be used as a percutaneous colostomy tube (T) was performed after confirmation of good anterograde urinary

drainage via the double-J stent (j). Subsequent tube review confirmed closure of the colorenal fistula.

Fig. 14. Computed tomography scan showing extravasation of contrast from the dilated left collecting system through the left PCN tract (t) into the descending colon (d). In this case the tract had matured without any appreciable extravasation of contrast into the retroperitoneal

conventional surgery (Lee, Patel et al. 1994).

**6. Role of percutaneous nephrostomy in transplanted kidneys** 

space.

**5.2.6 Death** 

The most common urological complications in transplanted kidneys are ureteral obstruction and leakage (Mostafa, Abbaszadeh et al. 2008). These should be recognized and treated early to prevent graft failure. Ureteral obstruction is most commonly due to stricture at the ureterovesical junction anastomosis, brought about by fibrosis secondary to ischemia or rejection and therefore presents late. Mostafa reported good success rates in the treatment of these strictures, by using stents and balloon dilatations inserted via the percutaneous nephrostomy tracts. Early ureteral obstruction on the other hand may be related to other factors such as blood clots, calculus, edema or ischemic necrosis. Similarly, percutaneous interventions may be performed in the treatment of these cases.
