Role of proximal drainage in obstruction in the urinary tract: an observational study

Subrata Kumar Das; Anshuman Panda; Tapas Ranjan Gupta; Arunava Chowdhury; Gouri Shankar Kesari; Sukanta Sen

doi:10.18203/2349-2902.isj20164454

Authors

Subrata Kumar Das Department of General Surgery, ICARE Institute of Medical Sciences and Research, Haldia, West Bengal, India
Anshuman Panda Department of General Surgery, ICARE Institute of Medical Sciences and Research, Haldia, West Bengal, India
Tapas Ranjan Gupta Department of General Surgery, ICARE Institute of Medical Sciences and Research, Haldia, West Bengal, India
Arunava Chowdhury Department of General Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
Gouri Shankar Kesari Department of General Medicine, ICARE Institute of Medical Sciences and Research, Haldia, West Bengal, India
Sukanta Sen Department of Pharmacology, ICARE Institute of Medical Sciences and Research, Haldia, West Bengal, India

DOI:

https://doi.org/10.18203/2349-2902.isj20164454

Keywords:

Complications, Outcome, Proximal drainage, Urinary tract obstruction, Urinary tract infection

Abstract

Background:Urinary tract obstruction may occur due to various causes at various levels. Proximal drainage implies drainage of the urinary tract proximal to the site of obstruction. This may be unilateral or bilateral and may be classified as follows: Renal- nephrostomy, pelvic-pyelostomy, ureteral-ureterostomy, vesical-cystostomy and urethral- urethrostomy. The aim of the present work would be to analyse the cases needed such drainage procedure in six months period in a tertiary care teaching hospital, Kolkata, India.

Methods: Proximal drainage operations done in series of 35 cases were standard nephrostomy, U-tube nephrostomy, percutaneous needle nephrostomy, end cutaneous ureterostomy, T-tube ureterostomy and suprapubic cystostomy. In 4 cases the drainage operations were done as emergency and lifesaving procedure. Seven drainage operations were done for permanent diversion of urine, 22 as preparatory to subsequent corrective or palliative surgery and 8 as adjuvant with corrective surgery. Clinical findings, post-operative complaints and results of investigations were noted and both pre and post-operative findings were compared to assess the ultimate results of the surgical treatment.

Results:Out of 9 cases of nephrostomy, 4 cases (44.44%) showed good result, 4 cases (44.44%) showed fair result and 1 case (11.11%) showed bad result. In 21 cases of T-tube ureterostomy, 15 cases (71.42%) showed good result, 3 cases (14.28%) showed fair result and 3 cases (14.28%) showed bad result. Out of the 6 cases of cutaneous ureterostomy, 4 cases (66.66%) showed good result, 1 cases (16.66%) showed fair result and 1 case (16.66%) showed bad result. The case had bad result (case no. 3) was a case of urinary tuberculosis with ureteric stricture at the lower third with hydroureteronephrosis and poorly functioning kidney on the other side. Out of the 3 cases of suprapubic cystostomy, 1 case showed good result and 2 cases showed fair result.

Conclusions:Drainage operation was done as preparatory to subsequent corrective or palliative surgery in majority of the cases. Proximal drainage helps controlling infection, normalizing blood biochemistry, regression of back pressure changes, in a word improving renal function. Proximal drainage of urine should be done before irreversible damage to the renal parenchyma occurs.

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