Abstract
Background: Obstructive nephropathy is a term describing the damage to the renal parenchyma that results from the obstruction to the flow of urine anywhere along the urinary system. Longterm obstruction causes chronic renal disease. 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, Indore.
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 suprapubiccystostomy. 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: In this series, bladder outlet obstruction comprised of 15 cases (42.85%) and ureteral obstruction comprised of 20 cases (57.14%), of which 1 case was due to carcinoma of the urinary bladder involving the ureteric orifices. 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.
Conclusion: 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.
Keywords: Urinary tract obstruction, Obstructive nephropathy, Proximal drainage, Nephrostomy, Urinary tract infection, Complications, Outcome.
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DOI: https://dx.doi.org/10.18535/jmscr/v5i7.55
