A Study Conducted on Complications Associated With Percutaneous Nephrostomy (PCN) at a Tertiary Care Center in Peshawar, Pakistan

Background Percutaneous nephrostomy (PCN) is a minimally invasive, image-guided procedure used to relieve urinary obstruction and preserve renal function. However, it carries a risk of both minor and major complications. This study evaluates the indications, success rate, and complications of ultrasound-guided PCN in patients with obstructive uropathy at a tertiary care center in Peshawar, Pakistan. Methods A prospective observational study was conducted in the Department of Urology at Hayatabad Medical Complex, Peshawar, over seven months (July 2024 to January 2025) following ethical approval (IREB No. 1886). A total of 117 patients who underwent ultrasound-guided PCN were included. Demographic data, clinical indications, success rates, and complications were documented over a one-week follow-up period. Data were analyzed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States). Results The mean age of patients was 50.54 ± 11.16 years (range: 27-82), with 68.4% (n = 80) being male and 31.6% (n = 37) female. The most common indication for PCN was malignancy (n = 57, 48.7%), followed by urinary stones (n = 30, 25.6%), pyonephrosis (n = 21, 17.9%), and pelvi-ureteric junction obstruction (n = 9, 7.7%). The overall success rate was 97.4% (114/117). Successful placement was achieved on the first attempt in 13.7% (n = 16) of cases, while 54.7% (n = 64) required two attempts, and 23.1% (n = 27) required three. Minor complications occurred in 29.9% (n = 35) of patients, with catheter blockage (n = 14, 12.0%), hematuria (n = 10, 8.5%), and catheter dislodgement (n = 7, 6.0%) being the most frequent. Major complications were observed in 6.8% (n = 8) of cases, with sepsis (n = 4, 3.4%) and bleeding requiring transfusion (n = 2, 1.7%) being the most common. Hematuria showed a significant association with the number of attempts (p = 0.040), whereas obesity was significantly linked to catheter dislodgment (p = 0.032) and urinary tract infections (UTIs) (p = 0.017). Conclusion Ultrasound-guided PCN is a highly effective procedure for managing obstructive uropathy, with a high success rate and relatively low complication rates. The risk of hematuria increases with multiple attempts, while obesity is significantly associated with catheter dislodgment and UTIs. Recognizing these risk factors can help optimize procedural planning and reduce complication rates.