Percutaneous nephrostomy, or nephropyelostomy, is an interventional procedure that is used mainly in the decompression of the renal collecting system. Since the publication of the first report describing this procedure in 1955,  percutaneous nephrostomy catheter placement has been the primary option for temporary and at times long term drainage of an obstructed collecting system. [2, 3, 4]
With proper training, technical success is achieved in more than 95% of cases. Diagnostic imaging often demonstrates the level and cause of obstruction; however, at the time of the catheter placement, the cause of obstruction may not be known. Often, the ureteral obstruction is acute and is caused by ureteral calculi or traumatic ureteral injury. In some cases, the obstruction has a chronic cause, such as urothelial malignancy or extrinsic compression associated with bleeding or neoplasm.
Frequently, the obstructed system becomes infected, and antibiotics are unable to penetrate the kidney when the purulent material cannot be drained. In these cases, percutaneous nephrostomy is an attractive treatment alternative. It allows decompression of the obstructed system, permits specimen collection, and creates a route for antibiotic instillation if needed. This procedure decreases the risk of urosepsis associated with acute surgical intervention. Often, patients may avoid surgery because the obstructing calculus spontaneously passes after the edema within the ureter subsides. If the obstruction is the result of postoperative edema, percutaneous nephrostomy allows the edema to subside. Percutaneous nephrostomy may similarly facilitate the management of urinary fistulas.
Indications for percutaneous nephrostomy include the following:
Urinary obstruction secondary to calculi
Urinary fistula and/or leaks e.g. traumatic or iatrogenic injury, malignancy, inflammation, hemorrhagic cystitis
Nondilated obstructive uropathy
Urinary tract obstruction related to pregnancy
Urinary obstruction related to renal transplant complications
As a part of decompression of perinephric fluid collections, e.g. abscess, urinoma
Access to the collecting system:
For interventions e.g. direct infusion of substances for dissolving stones, chemotherapy, and antibiotic and antifungal therapy
For endourological procedures e.g. stricture dilatation, antegrade ureteral stent placement, stone retrieval, pyeloureteroscopy, or endopyelotomy
Contraindications for percutaneous nephrostomy include the following:
Bleeding diathesis (most commonly, uncontrollable coagulopathy)
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Nasir H Siddiqi, MD Consultant Interventional Radiologist, King Faisal Specialist Hospital and Research Center; Associate Professor (Adj), Department of Radiology, Alfaisal University College of Medicine, Saudia Arabia
Disclosure: Nothing to disclose.
Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, Society of University Urologists
Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Cook Medical; Olympus.
Robert L Cirillo, Jr, MD, MBA Assistant Professor of Radiology, Florida State University College of Medicine; Medical Interventional Radiologist, Director/CEO, South Georgia Vascular Institute and South Georgia Laser Vein Center
Robert L Cirillo, Jr, MD, MBA is a member of the following medical societies: American Association for Physician Leadership, Society of Interventional Radiology, Society for Vascular Ultrasound, Cardiovascular and Interventional Radiological Society of Europe
Disclosure: Nothing to disclose.
Douglas M Coldwell, MD, PhD Professor of Radiology, Director, Division of Vascular and Interventional Radiology, University of Louisville School of Medicine
Douglas M Coldwell, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American College of Radiology, American Heart Association, American Physical Society, American Roentgen Ray Society, Society of Cardiovascular and Interventional Radiology, Southwest Oncology Group, and Special Operations Medical Association
Disclosure: Sirtex, Inc. Consulting fee Speaking and teaching
Fredric A Hoffer, MD, FSIR Professor of Radiology, University of Washington School of Medicine; Member, Quality Assurance Review Center
Fredric A Hoffer, MD, FSIR is a member of the following medical societies: Children’s Oncology Group, Radiological Society of North America, Society for Pediatric Radiology, and Society of Interventional Radiology
Disclosure: Nothing to disclose.
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