Indications, outcomes and complications of percutaneous nephrostomy at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Percutaneous nephrostomy (PCN) is an interventional radiology procedure whereby a flexible catheter is placed in the renal pelvis through the skin using image guidance. PCN is commonly performed for various benign and malignant indications and affords immediate decompression of the obstructed renal collecting system but can also be done for temporary urinary diversion in indications like urinary fistula, ureteric leaks and haemorrhagic cystitis. Laboratory, clinical and radiological outcomes post PCN placement are variable and influenced by several factors such as duration and extent of obstruction and status of contralateral kidney. Objective: To describe the indications, clinical, radiological and laboratory outcomes and complications of PCN at Moi Teaching and Referral Hospital, Eldoret Kenya. Methods: A prospective study was conducted on all 68 patients undergoing ultrasound guided PCN between June 2019 to May 2020.A census methodology was used. All patients who met the eligibility criteria and gave informed consent were enrolled in the study. Data collection form was used to record demographic and clinical data, renal ultrasonographic findings and laboratory investigations results, as well as complications. Data analysis done using SPSS software. Continuous variables were summarized using means and standard deviations, median and inter-quartile ranges (IQR) while categorical variables were summarized using frequencies and percentages. McNemar’s test was used to determine the differences in proportion in categorical data pre and post PCN while Wilcoxon Ranked test was used to determine differences pre and post PCN for continuous variables. All P values were two-sided at a 0.05 significance level. Results: PCN placement was successful in all the 68 patients. The mean age of the 68 patients included in the study was 37.62 ±12.5. (SD) years. A total of 38 (55.9%) of the patients were female. Malignancy was the most common indication for PCN n=55 (80.8%). Inflammatory indications and calculi were the second most common indications each constituting 4(5.8%). Cancer of the cervix was the commonest malignancy (32.7%) followed by prostate cancer. There was clinical improvement with reduction in degree and number of patients with oedema and flank pains 2 weeks post PCN.1(8.3%) patient discontinued dialysis two weeks post PCN. There was significant reduction in Urea, Creatinine and Potassium levels post PCN (Pvalue< 0.05). The study found a statistically significant increase in renal cortical thickness post PCN. There was no statistically significant change in parenchymal echogenicity and corticomedullary differentiation post PCN.15(22%) of the participants developed complications after PCN, of which major were 5(7.5%) and minor complications 10(14.5%).No deaths resulted from the procedure. Conclusion: Malignancy was the main indication for PCN in this study. PCN was associated with improved clinical and laboratory outcomes. Majority of the patients did not have any complications post PCN with most of the complications being minor