**9. References**

Ahmadzadeh, M. (1991). Clinical experience with subcutaneous urinary diversion: new approach using a double pigtail stent. *Br J Urol*, 67, 596-599.

1.0 post-operatively was reported. In five patients (17.9%) the system had to be replaced due to occlusion at a mean follow-up of 10.2 months. In three out of these five patients only the distal

Desgrandchamps et al. were the first authors to report use of a permanent PTFE-silicone EAS (Detour). They reported 3 patients who underwent successful EAS for ureteric necrosis, a rare complication of renal transplantation (Desgrandchamps et al., 1998). In 2001, the same group, reported use of the PTFE-silicone EAS in 27 patients with neoplastic (22) or benign (5) ureteric strictures. The mean follow-up was 6.3 months for the deceased patients and 47 months for the surviving ones, the longest follow-up being 84 months. In 3 cases, the EAS had to be removed due skin erosion in one and local tumour progression with bladder fistulae in two patients. Otherwise, five patients survived with the prosthesis in situ and a follow-up as long as 84 months without encrustation, infection, obstruction, or skin problems and with normally functioning kidneys (Jabbour et al., 2001). A prospective evaluation of their patients' quality using the EORTC QLC-30 questionnaire following insertion of the Detour EAS demonstrated an improvement of the function scale as a result of the elimination of the external percutaneous tube and a parallel worsening of the symptom scale secondary to the progression of disease (http://groups.eortc.be/qol/ questionnaires\_qlqc30.htm). Patient ratings of the global quality of life and satisfaction with the urinary diversion were high because of the absence of the percutaneous tube (Desgrandchamps et al., 2007). Other authors have since reported equally excellent results

with the Detour EAS (Lloyd et al., 2007; Olsburgh et al., 2007; Burgos et al., 2009).

need for open cystostomy incision (Aminsharifi et al., 2010).

mycotic therapy without removing the stent (Bynens et al., 2006).

**8. Conclusion** 

**9. References** 

nephrostomy drainage.

possible to design one soon.

Aminsharifi A et al. recently described a promising simple modification of using percutaneous access to the bladder utilizing a split Amplatz sheath, and thus obviating the

The main long-term complication reported is tumour invasion along the stent and active bladder cancer is the main contraindication to EAS insertion. One case report reported a patient presenting with acute obstruction of the Detour system secondary to a Candida infection that was managed successfully with short term nephrostomy and systemic anti-

The long term data show that EAS offers an excellent temporary or permanent internalization of urinary drainage with a minimally invasive method where open surgery has been tried and failed or was not considered feasible, and avoids the need for long-term

An ideal EAS should be associated with minimal or no peri-operative morbidity; whilst at the same time does not require regular changes. Such a stent does not currently exist but it is likely that the rapid advancement in tissue engineering and biomaterials will make it

Ahmadzadeh, M. (1991). Clinical experience with subcutaneous urinary diversion: new

approach using a double pigtail stent. *Br J Urol*, 67, 596-599.

part of the two-piece bypass was exchanged (Schmidbauer et al., 2006).


**18**

*Singapore* 

**Percutaneous Nephrostomy** 

*Dept of Diagnostic Radiology, Changi General Hospital* 

Rameysh D. Mahmood, Lee Yizhi and Mark Tan M.L.

Percutaneous nephrostomy (PCN) is a passageway that is introduced percutaneously into the renal pelvicalyces that can later be maintained by a tube, stent or catheter. Following its introduction by Wickbom in 1954 who described percutaneous puncture of the renal pelvis as a diagnostic procedure, Goodwin and Casey first described its therapeutic use for relief of urinary tract obstruction the following year in 1955 (Goodwin, Casey et al. 1955; Stables, Ginsberg et al. 1978). Since then, this now commonplace procedure has undergone significant progress in both its technical and imaging aspects, with improvisation of puncture devices and techniques, coupled with the advancing imaging modalities used to guide the procedure. Thanks to its good safety profile, percutaneous nephrostomy is the preferred technique for treatment of various urological conditions, and its pioneering role

This chapter aims to review the clinical use of percutaneous nephrostomy as well as the background technical aspects involved in carrying out the procedure. Some emphasis will be placed in the anatomical considerations that are crucial in determining approach as well as risk profile for an individual case. The associated known complications of the procedure will also be discussed, along with the therapeutic options available for the relevant

In essence, percutaneous nephrostomy may be performed for diagnostic or therapeutic purposes. For example, an antegrade pyelography can be performed following percutaneous nephrostomy to diagnose urinary tract obstruction. Its therapeutic uses on the other hand, can be seen to fall under two broad groups. Typically, the procedure is carried out to provide urinary diversion, and for a large number of cases this is related to urinary tract obstruction due to various causes. Secondly, the nephrostomy can be used to provide access to the urinary tracts for further intervention such as endopyeloscopy and

The following is a list of indications recognised by the Society of Interventional Radiology

for relief of urinary tract obstruction remains in good use until today.

**2. Indications and contraindications of percutaneous nephrostomy** 

nephrolithotomy. This is usually performed in collaboration with a urologist.

**1. Introduction** 

complications.

**2.1 Indications** 

(SIR) (Ramchandani, Cardella et al. 2003):

