Mp55-03 Percutaneous Nephrostomy (Pcn) as Initial Management in Infants With Suspected Upper Tract Obstruction: Indications, Complications and Outcomes

You have accessJournal of UrologyPediatrics IV (MP55)1 May 2024MP55-03 PERCUTANEOUS NEPHROSTOMY (PCN) AS INITIAL MANAGEMENT IN INFANTS WITH SUSPECTED UPPER TRACT OBSTRUCTION: INDICATIONS, COMPLICATIONS AND OUTCOMES Yifan M. Griffin, Konrad M. Szymanski, Joshua D. Roth, Pankaj Dangle, Benjamin M. Whittam, Kirstan K. Meldrum, Martin Kaefer, Richard C. Rink, and Rosalia Misseri Yifan M. GriffinYifan M. Griffin , Konrad M. SzymanskiKonrad M. Szymanski , Joshua D. RothJoshua D. Roth , Pankaj DanglePankaj Dangle , Benjamin M. WhittamBenjamin M. Whittam , Kirstan K. MeldrumKirstan K. Meldrum , Martin KaeferMartin Kaefer , Richard C. RinkRichard C. Rink , and Rosalia MisseriRosalia Misseri View All Author Informationhttps://doi.org/10.1097/01.JU.0001008616.01808.0f.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We report our institutional experience with PCN utilization in infants suspected to have obstructive uropathies. METHODS: We retrospectively reviewed medical records of patients≤1 year old who received PCN(s) as the first intervention to manage presumed upper tract obstruction(s) from 2012 to 2022 at a single institution. RESULTS: Seventy infants with hydronephrosis (63% male) underwent 84 initial PCN placements (46% left, 34% right, 20% bilateral; median age 25 days, median follow up 5 years). Eleven of 14 bilateral PCNs were placed synchronously. Pyelonephritis was the most common indication for PCN placement. Four PCNs were placed after retrograde pyelograms revealed pelvic dilations crossing the midline or multiple pathologies. 61 PCNs were placed with the final diagnosis of obstruction (57% UPJ, 23% UVJ, 8% ectopic, 5% ureterocele, 5% bladder outlet obstruction, 2% stone), 10 reflux, 11 both obstruction and reflux, and 2 neither (100% cystic dysplasia). Children remained with PCNs for a median of 43 days. Of patients with available lab results, 53% had elevated creatinine (Cr) at time of PCN placement; 50% reached Cr nadir with indwelling PCNs at 18 days (90% at 57 days). 37% of PCNs had mechanical issues post-placement: complete dislodgement (11), falling out of the collecting system (2), retracting into a posterior calyx (6), leakage (7) and broken stitch requiring suturing (5). One out of 7 children with urinary tract infections (UTIs) had septic shock on post-procedure day 1. One PCN had bleeding with clots that resolved with irrigation. No renal injuries, adjacent organ injuries, pneumothorax or hemothorax occurred during initial placement or replacement of PCNs. All PCNs were removed except in 3 patients who died from non-urologic causes. Most children underwent definitive surgery at a median age of 6 months. Patients were kept on antibiotic prophylaxis with indwelling PCNs. Pseudomonas and Klebsiella were the most common organisms on symptomatic and asymptomatic urine cultures, respectively. Only one urine culture grew a multidrug-resistant organism. Six patients developed pyelonephritis after PCN removal (Pseudomonas and Candida predominant). CONCLUSIONS: PCNs are temporizing measures. Creatinine takes up to 8 weeks to nadir after PCN placement. In children with symptomatic UTI and PCN, empiric therapy for Pseudomonas should be considered. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e917 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Yifan M. Griffin More articles by this author Konrad M. Szymanski More articles by this author Joshua D. Roth More articles by this author Pankaj Dangle More articles by this author Benjamin M. Whittam More articles by this author Kirstan K. Meldrum More articles by this author Martin Kaefer More articles by this author Richard C. Rink More articles by this author Rosalia Misseri More articles by this author Expand All Advertisement PDF downloadLoading ...