Purpose: The aim of the
study was to evaluate the usefulness of ultrasound contrast agent (UCA) in
ultrasound (US) guided percutaneous nephrostomy (PCN) and assessing
complications.
Patient and methods: 45 US
guided PCN were performed in 35 patients (age 69 ± 12 [38 - 91] years, 26 males
and 9 females) with hydronephrosis due to urinary tract obstruction. UCA (0.1
ml of SonoVue® diluted in 20 - 30 ml saline) was injected into the
renal collecting system to confirm the correct needle or catheter insertion and
determine the site and degree of the obstruction, using fluoroscopy as the gold
standard. Extravascular contrast enhanced ultrasound (EV-CEUS) was performed again on the
following day to assess complications.
Results: All 45 PCN were successfully performed under the guidance of US.
After the UCA was injected into the catheter, the site and degree of the
obstruction could be clearly shown with EV-CEUS in all 35 patients compared
with fluoroscopy. After the site of obstruction was defined, EV-CEUS showed
double kidneys in 2 patients, ureteral stones in 4 patients and abdominal focal
lesions that compress or block ureter in 19 patients. Catheter dislodgement was
diagnosed by administration of UCA in 5 patients, and required re-insertion of
the catheter. Hematoma (1 patient) and urine leakage (1 patient) were also
found.
Conclusions: Due to the advantages of US, such as safety, no radiation,
real time, bedside availability and time-saving, the combination of UCA and PCN
may become a new diagnostic and therapeutic method for clinical use in urology.
Key words: Percutaneous nephrostomy,
ultrasound, microbubbles, kidney, complication
