Mark F. Lynch

Percutaneous nephrostomy and ureteric stent insertion for acute renal deobstruction: Consensus based guidance

Objective: Ureteric obstruction can be relieved by either percutaneous nephrostomy (PCN) or retrograde ureteric stenting (RUS). Both are associated with variable technical success, complication rates, availability and quality of life issues. Our aim was to generate guidelines for PCN, RUS and the general approach of renal deobstruction in the UK. Materials and Methods: Subsequent to a pilot study, a formal postal questionnaire regarding the indication and method of renal deobstruction was sent via the BAUS audit office to members of BAUS, BSIR, BSUR. Data from 227 radiologists and urologists were categorised into areas of “clear agreement” (>75% agreement), “broad agreement” (50–75% agreement) and “no broad consensus” (less than 50% agreement) for any particular method of management. Results: In septic patients with renal obstruction, there was “clear agreement” for urgent deobstruction by PCN. If uncorrectable coagulopathy exists then RUS was the preferred option. There was “clear agreement” that patients with acute or chronic renal failure should be deobstructed during working hours if not septic, with “broad agreement” that this should be performed with PCN. Patients with obstruction subsequent to pelvic malignancy and the pregnant patient are discussed. Conclusion: The authors hope that these results and recommendations will aid clinical decision-making and aid the development of local and regional PCN and RUS services.

CURRENT OPINION AMONGST RADIOLOGISTS AND UROLOGISTS IN THE UK ON PERCUTANEOUS NEPHROSTOMY AND URETERIC STENT INSERTION FOR ACUTE RENAL UNOBSTRUCTION: RESULTS OF A POSTAL SURVEY

© 2 0 0 6 T H E A U T H O R S J O U R N A L C O M P I L A T I O N

PREVENTING THE FORGOTTEN URETERIC STENT: RESULTS FROM THE IMPLEMENTATION OF AN ELECTRONIC STENT REGISTER

The use of ureteric stents in urological practice is now routine, but is associated with shortand long-term complications. Early stent-related problems include pain, bothersome urinary symptoms, haematuria, UTI, and migration [1–4]. However, the sequelae from stents left in situ for long periods are more serious. In a series of 22 ‘forgotten’ stents left in situ for >6 months, Monga et al. [5] found that 68% were calcified, 45% fragmented, and 14% fragmented and calcified. In that series, 52% subsequently required ureteroscopy, 26% percutaneous nephroscopy, 32% ESWL, 3% open cystolitholapaxy, and 3% nephrectomy. Further reports also highlight the complicated management of patients with forgotten encrusted stents. A small series of encrusted retained stents was described by Borboroglu and Kane [6]; on average, patients needed between two and six endourological procedures to render them stoneand stent-free.

Current status of dynamic lymphoscintigraphy and sentinel lymph‐node biopsy in urological malignancies

The lymphatics were mapped using lymphangiograms taken via the dorsal penile lymphatics. The SLN was located initially using an anterior-posterior radiograph. The junction of the femoral head and the ascending ramus of the pubis were found most often to contain the SLN centre. This corresponded anatomically to the lymph nodes adjacent to the superficial epigastric vein, which were located medial and superior to the epigastric-saphenous junction.