Percutaneous Nephrostomy

Percutaneous Nephrostomy

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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, [1] 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 Diversion:

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)

Uncooperative patient

Severe hyperkalemia (>7 mEq/L); this should be corrected with hemodialysis before the procedure [5, 6, 7]

Goodwin WE, Casey WC, Woolf W. Percutaneous trocar (needle) nephrostomy in hydronephrosis. JAMA. 1955. 157:891.

Dyer RB, Assimos DG, Regan JD. Update on interventional uroradiology. Urol Clin North Am. 1997 Aug. 24(3):623-52. [Medline].

Kandarpa K, Aruny JE. Percutaneous Nephrostomy and Antegrade Ureteral Stenting. Handbook of Interventional Radiologic Procedures. 2nd ed. 1996. 201.

Luo H, Liu X, Wu T, Zhang X. Clinical application of percutaneous nephrostomy in some urologic diseases. J Huazhong Univ Sci Technolog Med Sci. 2008 Aug. 28(4):439-42. [Medline].

Kilic S, Oguz F, Kahraman B, Altunoluk B, Ergin H. Prospective evaluation of the alterations in the morphology and vascular resistance of the renal parenchyma with color Doppler ultrasonography after percutaneous nephrolithotomy. J Endourol. 2008 Apr. 22(4):615-21. [Medline].

Egilmez H, Oztoprak I, Atalar M, et al. The place of computed tomography as a guidance modality in percutaneous nephrostomy: analysis of a 10-year single-center experience. Acta Radiol. 2007 Sep. 48(7):806-13. [Medline].

Hausegger KA, Portugaller HR. Percutaneous nephrostomy and antegrade ureteral stenting: technique-indications-complications. Eur Radiol. 2006 Sep. 16(9):2016-30. [Medline].

von der Recke P, Nielsen MB, Pedersen JF. Complications of ultrasound-guided nephrostomy. A 5-year experience. Acta Radiol. 1994 Sep. 35(5):452-4. [Medline].

Kumar P. Radiation safety issues in fluoroscopy during percutaneous nephrolithotomy. Urol J. 2008 Winter. 5(1):15-23. [Medline].

Chuang MT, Lu CH, Tsai YS, Tsai HM, Kuo TN, Liu YS. Comparative study of percutaneous nephrostomy using catheters with and without locking strings. Clin Nephrol. 2011 Sep. 76(3):226-32. [Medline].

Dyer RB, Regan JD, Kavanagh PV, Khatod EG, Chen MY, Zagoria RJ. Percutaneous nephrostomy with extensions of the technique: step by step. Radiographics. 2002 May-Jun. 22(3):503-25. [Medline].

Shen CH, Cheng MC, Lin CT, Jou YC, Chen PC. Innovative metal dilators for percutaneous nephrostomy tract: report on 546 cases. Urology. 2007 Sep. 70(3):418-21; discussion 421-2. [Medline].

Ozok HU, Sagnak L, Senturk AB, Karakoyunlu N, Topaloglu H, Ersoy H. A Comparison of Metal Telescopic Dilators and Amplatz Dilators for Nephrostomy Tract Dilation in Percutaneous Nephrolithotomy. J Endourol. 2011 Oct 14. [Medline].

Williams SK, Bird VG, Maurici G, Leveillee RJ. Borrowing from interventional radiology: novel technique to dilate scarred nephrostomy tract. Urology. 2008 Nov. 72(5):1156-8. [Medline].

Pollard AJ, Nicholson DA. Percutaneous nephrostomy: how to do it. J Intervent Radiol. 1994. 9:129-41.

Sivalingam S, Al-Essawi T, Hosking D. Percutaneous nephrolithotomy with retrograde nephrostomy access: a forgotten technique revisited. J Urol. 2013 May. 189(5):1753-6. [Medline].

Cui XW, Ignee A, Maros T, Straub B, Wen JG, Dietrich CF. Feasibility and Usefulness of Intra-Cavitary Contrast-Enhanced Ultrasound in Percutaneous Nephrostomy. Ultrasound Med Biol. 2016 Sep. 42 (9):2180-8. [Medline].

Tokue H, Takeuchi Y, Arai Y, Tsushima Y, Endo K. Anchoring system-assisted coil tract embolization: a new technique for management of arterial bleeding associated with percutaneous nephrostomy. J Vasc Interv Radiol. 2011 Nov. 22(11):1625-9. [Medline].

Misra S, Coker C, Richenberg J. Percutaneous nephrostomy for ureteric obstruction due to advanced pelvic malignancy: have we got the balance right?. Int Urol Nephrol. 2013 Jun. 45(3):627-32. [Medline].

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

Nasir H Siddiqi, MD is a member of the following medical societies: American College of Radiology, American Medical Association, American Roentgen Ray Society, Radiological Society of North America

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.

Percutaneous Nephrostomy

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