Salvage of dislodged percutaneous nephrostomy catheter through the original tract: feasibility and factors affecting technical failure of reinsertion.

Abstract

Objectives: Percutaneous nephrostomy (PCN) is a standard procedure to relieve urinary obstruction. Inadvertent catheter dislodgement occurs in up to 15% of cases, and one of the management options is to replace the new catheter through the original tract. Although previous studies have reported the feasibility of reinserting a new catheter through the original tract, few studies have described the factors contributing to technical failure. This study aims to investigate the feasibility and factors affecting the technical failure of reinsertion of dislodged PCN.

Methods: 53 procedures of 42 patients who underwent reinsertion of dislodged PCN through the original tract were retrospectively reviewed. All procedures were performed under fluoroscopic guidance using an angiographic catheter and a guidewire to search the original tract. After confirming access to the renal pelvis, a new catheter was inserted. Technical success was defined as the successful placement of a new catheter through the original tract. Patient characteristics, procedure details, and duration since initial PCN placement, the last replacement and dislodgement were statistically compared between technical success and failure groups.

Results: Technical success was achieved in 45 of 53 procedures (85%). Univariate analysis revealed that significant factors affecting technical failure were the smaller size of the catheter (P = 0.05), procedure time (P =  < 0.001), and duration since initial PCN placement (P = 0.001). Sex was also a significant factor; however, this may be the error due to the small sample size.

Conclusion: Salvage of dislodged PCN by inserting a catheter through the original tract was feasible. However, technical failure of catheter reinsertion was significantly affected by the shorter duration since initial PCN placement and the smaller size of catheters.