Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Urol. Sep 12, 2020; 9(1): 1-8
Published online Sep 12, 2020. doi: 10.5410/wjcu.v9.i1.1
Estimation of successful capping with complete aspiration of bladder via nephroureterostomy tube
Majid Maybody, Wesley K Shay, Deborah A Fleischer, Meier Hsu, Chaya Moskowitz
Majid Maybody, Wesley K Shay, Deborah A Fleischer, Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
Meier Hsu, Chaya Moskowitz, Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
Author contributions: Maybody M contributed to study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, and critical revision; Shay WK and Fleischer DA contributed to acquisition of data and critical revision; Hsu M and Moskowitz C contributed to analysis and interpretation of data, critical revision.
Supported by National Institute of Health (United States), No. P30 CA008748.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board/Privacy Board-B. The IRB determined that the protocol meets the requirements as set forth in the regulatory criteria for research approval and has been granted approval for 12 mo.
Informed consent statement: Your request to waive the requirement to obtain written informed consent and a research authorization has been granted.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Majid Maybody, MD, Associate Professor, Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, No. 1275 York Avenue, M276C, New York, NY 10065, United States. maybodym@mskcc.org
Received: April 9, 2020
Peer-review started: April 9, 2020
First decision: June 7, 2020
Revised: July 16, 2020
Accepted: August 15, 2020
Article in press: August 15, 2020
Published online: September 12, 2020
Processing time: 152 Days and 14.3 Hours
Abstract
BACKGROUND

Ureteral stent and nephroureterostomy tube (NUT) are treatments of ureteral obstruction. Ureteral stent provides better quality of life. Internalization of NUT is desired whenever possible.

AIM

To assess outcomes of capping trial among cancer patients with complete aspiration of retained contrast from bladder via NUT.

METHODS

Our Institutional Review Board approved retrospective review of all NUT placement, NUT exchange and conversion of nephrostomy catheter into NUT performed during June 2013 to June 2015 (n = 578). Cases were excluded due to lack of imaging of bladder (n = 37), incomplete aspiration of bladder (n = 324), no attempt at capping NUT (n = 166), and patients with confounding factors interfering with results of capping trial including non-compliant bladder, bladder outlet obstruction and catheter malposition (n = 14). Study group consisted of 37 procedures in 34 patients (male 19, female 15, age 2-83 years, average 58, median 61) most with cancer (prostate 8, endometrial 5, bladder 4, colorectal 4, breast 2, gastric 2, neuroblastoma 2, cervical 1, ovarian 1, renal 1, sarcoma 1, urothelial 1 and testicular 1) and one with Crohn’s disease. Medical records were reviewed to assess outcomes of capping trial. Exact 95% confidence intervals (95%CI) were calculated.

RESULTS

Among patients with complete aspiration of retained contrast, 30 (81%, 95%CI: 0.65-0.92) catheters were successfully capped (range 12-94 d, average 40, median 24.5) until planned conversion to internal stent (23), routine exchange (5), removal (1) or death unrelated to catheter (1). Seven capping trials (19%, 95%CI: 0.08-0.35) were unsuccessful (range 2-22 d, average 12, median 10) due to leakage (3), elevated creatinine (2), fever/hematuria (1) and nausea/vomiting (1).

CONCLUSION

Capping trial success among patients with complete aspiration of retained contrast/urine from bladder via NUT appears high.

Keywords: Nephroureterostomy tube; Ureteral stent; Capping trial; Internalization; Conversion; Percutaneous nephrostomy

Core Tip: Patients with ureteral obstruction are best treated with cystoscopic placement of ureteral stent because of a better quality of life. When ureteral stent placement is not possible, a nephroureterostomy tube (NUT) is placed. Once the acute clinical problem is resolved, internalization is sought in order to improve patient’s quality of life. Currently all patients undergo NUT capping trial which is needed before internalization. This work helps urologists and interventional radiologists to estimate success of capping trial. It helps define the endpoint of NUT placement or exchange interventions with potential benefits to patients and health care systems.