Percutaneous nephrostomy for upper urinary tract obstruction at Muhimbili national hospital: patients’ presentation, challenges and outcome of the procedure

Abstract

Background: Upper Urinary tract obstruction is a common problem encountered by urologists, primary care physicians, and emergency medicine physicians. Percutaneous nephrostomy (PCN) is a widely used interventional procedure for upper urinary diversion and decompression of the renal collecting system in varied clinical settings. Despite it being a basic urological procedure, it remains technically challenging to perform. Aim; This study assessed the clinical profile and characteristics of patients with upper urinary tract obstruction undergoing Percutaneous nephrostomy, including outcome and challenges related to the procedure at MNH. Methodology: This was a retrospective cross sectional study, which was conducted at Muhimbili National Hospital from June 2020 to April 2021. Sociodemographic characteristics, Clinical presentation and underlying conditions were analysed by descriptive statistics using SPSS version 23 and then summarized into tables and figures. Categorical variables were analyzed in proportions while continuous variables were analysed into means. The means were compared by a paired t-test and a p-value of <0.05 was considered significant. Results; The study involved 75 patients with mean age of 52.25 ± 11.74 years (33-79 years) who underwent PCN from January 2018 to June 2020. Amongst all patients 67 (89.3%) were female and 8 (10.7%) were male. The underlying conditions included cervical cancer (76%), bladder cancer (6.7%). Others were ureteric injury (5.3%), prostate cancer (4.0%), ovarian cancer (4.0%) and colorectal cancer (2.7%). Common clinical presentations were oliguria (90.7%), vomiting (77.3%) and flank pain (64%) others; were abdominal pain (44%), Confusion (30.7%) and hematuria (9.3). There was an improvement in creatinine and BUN levels, which occurred in 88% of patients after PCN. There was significant decrease in mean level of serum creatinine from 1100.02 ±73.10 μmol/l before PCN to 529.55 ± 54.46 μmol/l 2-4weeks after PCN (p < 0.01), Mean BUN dropped from 29.03 ± 1.51 mmol/l before PCN to 14.57 ± 0.91mmol/l 2 to 4 weeks post PCN (p< 0.01). Short-term complications included tube dislodgement (40%), infection/sepsis (30.7%), pain (19%), urine leakage (8%) and tube blockage (5.2%). Deaths occurred in 14.7% of patients within a month after PCN. Challenges reported in delivering PCN services included shortage of medical supplies and affordability of the services by patients. Conclusion; Malignant causes of UUTO are among the commonest underlying conditions in patients undergoing PCN in our setting. Majority of patients undergoing PCN presents with early stage of kidney failure and uremia. PCN is a minimally invasive procedure for urinary diversion in UUTO with improved renal function and notable short-term complications. Inadequate medical supplies and affordability of the PCN were reported challenges.