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Safety and Efficacy of Ultrasound-Guided Percutaneous Nephrostomy in Oncology Patients
Sponsor: Assiut University
Summary
Obstructive uropathy is a serious complication frequently seen in cancer patients, occurring when urine flow from the kidneys is blocked by tumor compression, invasion, or benign etiologies such as radiation-induced strictures and stones. If left untreated, this blockage leads to hydronephrosis, acute kidney impairment, and interruptions in cancer therapy. When internal ureteral stenting fails or is not possible, percutaneous nephrostomy (PCN), which involves inserting a small drainage tube through the back directly into the renal collecting system, is required to decompress the kidney and preserve renal function. Traditionally, PCN is performed under fluoroscopy, exposing patients and healthcare staff to ionizing radiation. Ultrasound guidance provides continuous real-time visualization of the renal structures while completely eliminating radiation hazards. The primary purpose of this prospective interventional study is to evaluate the technical success, safety, and complication rates of ultrasound-guided percutaneous nephrostomy in oncology patients presenting with urinary tract obstruction. Participants in this study undergo ultrasound-guided PCN under local anesthesia using the standard Seldinger technique to place an 8Fr pigtail drainage catheter. The study evaluates the technical success rate of the procedure, procedural and post-procedural complications (such as bleeding or sepsis), recovery of kidney function measured by changes in serum creatinine levels, and hospital length of stay.
Key Details
Gender
All
Age Range
18 Years - Any
Study Type
INTERVENTIONAL
Enrollment
40
Start Date
2026-11
Completion Date
2027-12
Last Updated
2026-10-02
Healthy Volunteers
No
Interventions
Ultrasound-guided percutaneous nephrostomy
Ultrasound-guided placement of a percutaneous nephrostomy (PCN) catheter using the standard Seldinger technique. Under local anesthesia (1% or 2% lidocaine) and continuous real-time ultrasound visualization without fluoroscopy, access to the dilated pelvicalyceal system is achieved via posterolateral puncture targeting a lower pole posterior calyx using an 18-gauge needle (or 21/22-gauge Chiba needle). A 0.035-inch or 0.038-inch J-tip guidewire is advanced and coiled within the renal pelvis. The tract is serially dilated over the guidewire using sequential fascial dilators, followed by insertion of an 8Fr locking pigtail nephrostomy catheter into the renal collecting system. Proper intrapelvic positioning is confirmed sonographically and via free drainage of urine. The catheter is locked, sutured to the skin with non-absorbable sutures, dressed sterilely, and connected to an external gravity drainage bag.