Nephrostomy: Difference between revisions
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[[File:Pigtail catheter settings.jpg|thumb|300px|Various settings of a 6 [[French catheter scale|French]] pigtail catheter with locking string, obturator (also called ''stiffening cannula'') and puncture needle. <br>'''A'''. Overview <br>'''B'''. Both puncture needle and obturator engaged, allowing for direct insertion. <br>'''C'''. Puncture needle retracted. Obturator engaged. Used for example in steady advancement of the catheter on a guidewire previously inserted into the renal pelvis through a thin needle.<br>'''D'''. Both obturator and puncture needle retracted, when the catheter is in the renal pelvis. <br>'''E'''. Locking string is pulled (bottom center) and then wrapped and attach to the superficial end of the catheter.]] |
[[File:Pigtail catheter settings.jpg|thumb|300px|Various settings of a 6 [[French catheter scale|French]] pigtail catheter with locking string, obturator (also called ''stiffening cannula'') and puncture needle. <br>'''A'''. Overview <br>'''B'''. Both puncture needle and obturator engaged, allowing for direct insertion. <br>'''C'''. Puncture needle retracted. Obturator engaged. Used for example in steady advancement of the catheter on a guidewire previously inserted into the renal pelvis through a thin needle.<br>'''D'''. Both obturator and puncture needle retracted, when the catheter is in the renal pelvis. <br>'''E'''. Locking string is pulled (bottom center) and then wrapped and attach to the superficial end of the catheter.]] |
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Nephrostomies are created by [[surgeon]]s or [[interventional radiology|interventional radiologist]]s |
Nephrostomies are created either by [[surgeon]]s or [[interventional radiology|interventional radiologist]]s. |
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Under interventional radiology, the subject either lies down on the side or in a prone position. An area is selected below the 12th rib, bounded by the posterior axillary line and the muscles of the spine. The exact area is then located by ultrasound. Local anesthetic infiltration is used to numb the area. Then a needle would pass through to make the puncture on the kidney.<ref name="Jairath 2017"/> |
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Then a [[catheter]] would pierces the [[skin]] and rests in the [[urinary tract]]. {{citation needed|date=February 2022}} |
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Urine is collected in an external bag which can be emptied as often as necessary. |
Urine is collected in an external bag which can be emptied as often as necessary. |
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Revision as of 02:59, 4 February 2023
| Nephrostomy | |
|---|---|
 Drawing of a nephrostomy tube in a human female | |
| ICD-9-CM | 55.02 |
| MeSH | D009403 |
| OPS-301 code | 5-550 |
A nephrostomy or percutaneous nephrostomy is an artificial opening created between the kidney and the skin which allows for the urinary diversion directly from the upper part of the urinary system (renal pelvis). It is an interventional radiology/surgical procedure in which the renal pelvis is punctured whilst using imaging as guidance. Images are obtained once an antegrade pyelogram (an injection of contrast), with a fine needle, has been performed. A nephrostomy tube may then be placed to allow drainage.[2]
An urostomy is a related procedure performed more distally along the urinary system to provide urinary diversion.
Uses
A nephrostomy is performed whenever a blockage keeps urine from passing from the kidneys, through the ureter and into the urinary bladder. Without another way for urine to drain, pressure would rise within the urinary system and the kidneys would be damaged.[citation needed]
The most common cause of blockage necessitating a nephrostomy is cancer, especially ovarian cancer and colon cancer. Nephrostomies may also be required to treat pyonephrosis, hydronephrosis and kidney stones.[3]
Diagnosis
Percutaneous nephrostomy is used in Whitaker test to differentiate recurrent obstruction or permanent dilatation after an operative surgery that corrects the cause of obstruction. This procedure is also used for antegrade pyelography to visualize the upper urinary tract system.[4]
Treatment
Percutaneous nephrostomy is also used to treat hydronephrosis caused by kidney stones, pregnancy, stricture of the urinary tract, urinary tract/cervical/prostate tumours. Besides, infections such as urosepsis and pyonephrosis can also be drained by nephrostomy tube insertion.[4] Percutaneous nephrostomy is also useful in divert urine away from diseased site to enhance healing. Examples of conditions that can be treated with such method are malignant/traumatic/inflammatory fistula, and haemorrhagic cystitis.[4]
Percutaneous nephrostomy is also used to provide access for chemotherapy/antibiotic/antifungal therapy, antegrade urethral stent placement, stone retrieval, and endopyelotomy (endoscopic surgery for the enlargement of the junction of renal pelvis and ureter).[4]
Process
A. Overview
B. Both puncture needle and obturator engaged, allowing for direct insertion.
C. Puncture needle retracted. Obturator engaged. Used for example in steady advancement of the catheter on a guidewire previously inserted into the renal pelvis through a thin needle.
D. Both obturator and puncture needle retracted, when the catheter is in the renal pelvis.
E. Locking string is pulled (bottom center) and then wrapped and attach to the superficial end of the catheter.
Nephrostomies are created either by surgeons or interventional radiologists.
Under interventional radiology, the subject either lies down on the side or in a prone position. An area is selected below the 12th rib, bounded by the posterior axillary line and the muscles of the spine. The exact area is then located by ultrasound. Local anesthetic infiltration is used to numb the area. Then a needle would pass through to make the puncture on the kidney.[4]
Then a catheter would pierces the skin and rests in the urinary tract. [citation needed]
Urine is collected in an external bag which can be emptied as often as necessary.
Risks
Percutaneous nephrostomy is overall a very safe procedure.[5] Risks and complications include:[5]
- Malposition
- Intra-peritoneal leakage, causing ascites
- Hemorrhage
- Infection. This can generally be treated with antibiotics.
Although pneumothorax and colonic injury are more common on subcostal needle insertion, these are rare complications.[4]
Blood in urine usually clears up after 48 to 72 hours. Bleeding longer than this period may signifies more serious bleeding complication. About 2 to 4% of percutaneous nephrostomy cases require blood transfusion.[6]
See also
References
- ^ Content initially copied from: Hansen KL, Nielsen MB, Ewertsen C (December 2015). "Ultrasonography of the Kidney: A Pictorial Review". Diagnostics. 6 (1): 2. doi:10.3390/diagnostics6010002. PMC 4808817. PMID 26838799. (CC-BY 4.0)
- ^ Longmore M, Wilkinson I, Turmezei T, Cheung CK (2007). Oxford Handbook of Clinical Medicine (7th ed.). Oxford University Press. p. 731. ISBN 978-0-19-856837-7.
- ^ Hautmann, Stefan H (October 22, 2015). "Nephrostomy". Medscape. WebMD LLC. Retrieved September 16, 2017.
- ^ a b c d e f Jairath A, Ganpule A, Desai M (2017-11-29). "Percutaneous nephrostomy step by step". Mini-invasive Surgery. 1: 180–185. doi:10.20517/2574-1225.2017.24. ISSN 2574-1225.
- ^ a b "Percutaneous Nephrostomy". University Hospital Southampton, NHS Foundation Trust. Retrieved 2019-02-06.
- ^ Smith M, Rochon PJ, Ray CE (June 2012). "Traversing the Renal Pelvis during Percutaneous Nephrostomy Tube Placement ("Kidney Kabob")". Seminars in Interventional Radiology. 29 (2): 150–152. doi:10.1055/s-0032-1312578. PMC 3444877. PMID 23729987.