Percutaneous Nephrostomy

Percutaneous nephrostomy is a medical procedure used to divert the flow of urine away from the kidneys when there is an obstruction or blockage in the urinary tract.

Indications

• Treatment of obstructive uropathy, where the flow of urine is blocked due to kidney stones, tumors, or other conditions
• Diversion of urine in cases of ureteral obstruction or injury
• Palliative care for patients with advanced cancer or other terminal illnesses
• Temporary measure until a more definitive treatment can be performed

Procedure

The procedure involves the insertion of a catheter through the skin and into the kidney to drain urine directly from the kidney.

1. The patient is given local anesthesia and/or sedation to minimize discomfort and pain
2. Imaging guidance, such as ultrasound or fluoroscopy, is used to locate the kidney and guide the catheter insertion
3. A small incision is made in the skin, and a needle is inserted into the kidney under imaging guidance
4. A guidewire is then inserted through the needle, and the catheter is advanced over the guidewire into the kidney
5. The catheter is secured in place with sutures or adhesive, and a collection bag is attached to collect urine

Types of Nephrostomy Tubes

• Temporary nephrostomy tubes: used for short-term drainage and are typically removed after the obstruction is relieved
• Long-term nephrostomy tubes: used for prolonged drainage and may require periodic replacement or maintenance
• Locking nephrostomy tubes: have a locking mechanism to prevent accidental dislodgement

Risks and Complications

• Bleeding or hemorrhage at the insertion site
• Infection of the kidney or urinary tract
• Damage to surrounding organs, such as the bowel or liver
• Nephrostomy tube dislodgement or blockage
• Pain or discomfort at the insertion site

Post-Procedure Care

After the procedure, patients are typically monitored for several hours to ensure that the nephrostomy tube is functioning properly and that there are no complications.

• Patients may experience pain or discomfort at the insertion site, which can be managed with medication
• The collection bag should be emptied regularly to prevent overflow and maintain hygiene
• Patients should follow aseptic technique when handling the nephrostomy tube and collection bag to minimize the risk of infection

Follow-Up Care

Regular follow-up appointments are necessary to monitor the patient's condition, check for complications, and maintain the nephrostomy tube.

• Patients should schedule follow-up appointments with their healthcare provider as recommended
• The nephrostomy tube may need to be replaced or adjusted periodically to ensure proper function
• Patients should report any signs of complications, such as pain, bleeding, or infection, to their healthcare provider promptly