Nephrostomy

<Procedures>

<Index>

 

 

 

Definition

-  Artificial opening through abdominal wall into renal pelvis allowing direct drainage of urine

 

Rationale

-  Provides urinary drainage when ureter is obstructed & retrograde access contraindicated

-  Provides access to upper tract for endourologic procedures

-  Intracorporeal lithotripsy

-  Chemical stone dissolution

-  Double-J stent placement

-  Antegrade imaging of ureter

 

Indications

-  Ca: ovarian, colon

-  Pyonephrosis

-  Urolithiasis, obstructive uropathy

 

Procedure

-  Pre-op

-  Nil fasting if under local

-  Abx

-   Cephalosporin OR

-   Penicillin + Aminoglycoside

-  Performed by surgeon or interventional radiologist

-  Aided by ultrasound, CT fluoroscopy or II

-  Local anaesthetic

-  Needle inserted under guidance

-  Infracostal approach --> lower pole calyx, less pneumothorax/hydrothorax

-  Guidewire inserted though needle

-  Needle removed & catheter (8-14F) inserted over guidewire

-  Affix to catheter to skin

 

 

Contraindications

-  Bleeding diathesis

-  Uncontrolled hypertension

 

Complications

-  Infection

-  Haemorrhage

-  May require clamping of tube for 0.5-2hrs --> irrigation with NaCl 0.9%

-  Pneumothorax, hydrothorax, pleural effusion

-  Haematuria for several hrs

-  Post-obstructive diuresis (polyuria)

-  Liver, spleen or bowel injury <1%

-  Mortality <0.05%

 

 

 

Reference

 

Pic (adapted): www.zina-studio.com/p447740290/h20A3F5C5#h20a3f5c5