Main Article Content
nephrostomy, antegrade stent, training, urologist, emergency
Background and Objective
Renal obstruction is a common urological emergency potentially requiring urgent decompression by percutaneous nephrostomy (PCN) or antegrade ureteric stent (AUrS), procedures performed by interventional radiologists, or retrograde stenting in theatre by a urologist.
The study aimed to assess the burden of PCN / AUrS on the overall workload of a urology department and evaluate impact of procedural delays in terms of bed-occupancy and cost.
The findings serve to explore whether formal PCN / AUrS training would be desirable for UK trainees in urology.
Material and Methods
Prospective study of all patients admitted under urology at Queen Elizabeth Hospital Birmingham (QEHB) between 20thOctober - 18thNovember 2018.
Electronic records to retrieve data pertaining to admission, treatment provided, length of in-patient stay and delay awaiting PCN / AUrS.
n=148 patients identified.
n=22 (14.8% of total) primary admission reason and/or main treatment provided related to PCN / AUrS.
601 urology in-patient days occupied for all causes, 166 (27.6%) related to PCN / AUrS and 66 (10.9%) awaiting PCN / AUrS (delays cost £11,361 / month).
PCN / AUrS constituted a noteworthy proportion of all admissions and in-patient bed days in QEHB urology.
Clinically non-urgent patients experienced notable cumulative delays whilst awaiting PCN / AUrS which adversely impacted bed occupancy.
A suitably trained urologist competent at PCN / AUrS may positively address these issues.
The findings merit consideration of a call for UK urology trainees to be trained in PCN / AUrS as part of CCT requirements.
2) de Sousa Morais N, Pereira J, Mota P, et al. Percutaneous nephrostomy vs ureteral stent for hydronephrosis secondary to ureteric calculi: impact on spontaneous stone passage and health-related quality of life—a prospective study. Urolithiasis. 2018;.
3) Acute kidney injury: prevention, detection and management | Guidance and guidelines | NICE [Internet]. 2019 Available from: https://www.nice.org.uk/guidance/cg169 (2019, accessed 14 February 2019)
4) Turk C, Skolarikos A, Neisius A, et al. EAU Guidelines on Urolithiasis. Arnhem, The Netherlands, European Association of Urology, 2019. Available at: https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Urolithiasis-2018-large-text.pdf
5) ElSheemy M, Shouman A, Shoukry A, et al. Ureteric stents vs percutaneous nephrostomy for initial urinary drainage in children with obstructive anuria and acute renal failure due to ureteric calculi: a prospective, randomised study. BJU Int. 2014;115(3):473-479.
6) Dudderidge T, Kayes O. Urology Led Ultrasound Services – Time to Focus. BJU Int. 2007; 981-983.
7) Surange RS, Jeygopal NS, Chowdhury SD, et al. Bedside ultrasound: a useful tool for the on-call urologist?. Int Urol Nephrol. 2001;32(4):591-6.
8) Talreja S, Banerjee I, Teli R, et al. A Spectrum of Urological Emergency Reported at a Tertiary Care Teaching Hospital: An Experience. J Clin Diag Res. 2015; 9(11):12.
9) Moslemi MK, Mahfoozi B. Urologist-operated ultrasound and its use in urological outpatient clinics. Patient Prefer Adher. 2011;5:85.
10) Nargund VH, Cumming JA, Jerwood D, et al. Ultrasound in urological emergency: results of self audit and implications for training. Int Urol Nephrol. 1996;28(3):267–271.
11) Lee C, Anderson JK, Monga M. Residency Training in Percutaneous Renal Access: Does it Affect Urological Practice? J Urol. 2004; 171(2): 592-5
12) El-Assmy AM, Shokeir AA, Mohsen T, et al. Renal access by urologist or radiologist for percutaneous nephrolithotomy—is it still an issue? J Urol. 2007;178(3):916-20.
13) Armitage JN, Withington J, Fowler S, et al. BAUS section of Endourology. Percutaneous nephrolithotomy access by urologist or interventional radiologist: practice and outcomes in the UK. BJU Int. 2017;119(6):913-8.
14) Skolarikos A, Alivizatos G, Papatsoris A, et al. Ultrasound-guided percutaneous nephrostomy performed by urologists: 10-year experience. Urology. 2006;68(3):495-9.
15) Chalmers N, Jones K, Drinkwater K, et al. The UK nephrostomy audit. Can a voluntary registry produce robust performance data? Clin Radiol. 2008;63(8):888-94.
16) Masood J, Yeo L, Zaman F, et al. Should urologists in the UK undertake their own nephrostomies and renal access for endourological procedures: what does the future hold?. BJU Int. 2009;104(6):755-7.
17) The Royal College of Radiology Sub-Specialty Curriculum for Interventional Radiology. Available from: https://www.rcr.ac.uk/sites/default/files/ir_curriculum-2016_final_15_november_2016.pdf [last accessed 12 May 2019]
18) Masood J, Ismail M, El-Husseiny T, et al. ‘An interventional urology list’–a novel concept for UK urological services. Ann R Coll Surg Engl. 2010;93(1):27-30.