- Author: Nasir H Siddiqi, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS more...
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 the temporary 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 tube 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 because 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. The same is true with urinary fistulas.
Indications for percutaneous nephrostomy include the following:
Temporary urinary diversion associated with urinary obstruction secondary to calculi
Diversion of urine from the renal collecting system in an attempt to heal fistulas or leaks resulting from traumatic or iatrogenic injury, malignant or inflammatory fistulas, or hemorrhagic cystitis
Treatment of nondilated obstructive uropathy
Treatment of urinary tract obstruction related to pregnancy
Treatment of complications related to renal transplants
Access for interventions such as direct infusion of substances for dissolving stones, chemotherapy, and antibiotic or antifungal therapy
Access for other procedures (eg, benign stricture dilatation, antegrade ureteral stent placement, stone retrieval, pyeloureteroscopy, or endopyelotomy)
Decompression of nephric or perinephric fluid collections (eg, abscesses or urinomas)
Contraindications for percutaneous nephrostomy include the following:
Bleeding diathesis (most commonly, uncontrollable coagulopathy)
Severe hyperkalemia (>7 mEq/L); this should be corrected with hemodialysis before the procedure [5, 6, 7]
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