Complication upon complication — minimally invasive management of fragmented percutaneous nephrostomy

Abstract

Ureteral obstruction, a complex clinical condition, often necessitates decompression, commonly achieved through nephrostomy tube placement. This minimally invasive procedure connects the renal collecting system to the skin via a draining catheter, frequently performed to relieve obstructions caused by stones, malignancies, and strictures. Despite a high technical success rate of 99%, unexpected complications such as tube fragmentation can occur.

This case study highlights a rare instance of polyurethane nephrostomy tube fragmentation in a 45-year-old woman following a hysterectomy for endometrial adenocarcinoma. Initial imaging revealed uterine injury, leading to the placement of a nephrostomy tube and a double-J stent. Two weeks later, the patient experienced a tube fracture, necessitating minimally invasive retrieval of the fragment and subsequent laparoscopic ureter repair. The postoperative period was complication-free, emphasizing the need for nephrostomy care and prompt management of complications. This case underscores the importance of proper insertion techniques, regular replacements, and careful monitoring to prevent and address such issues effectively.