Publication:

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

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.