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Nephrostomy Workup

  • Author: Stefan H Hautmann, MD, PhD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
Updated: Oct 22, 2015

Laboratory Studies

See the list below:

  • Bleeding time, as indicated
  • Prothrombin time
  • Platelet count
  • Activated partial thromboplastin time (aPTT)
  • CBC count
  • Urine culture
  • Electrolyte assessment
  • Creatinine assessment

Imaging Studies

Any of the following studies can be used to assess patient anatomy:

  • Intravenous pyelography (IVP)
  • Abdominal CT scanning, shown in the images below
  • Renal ultrasonography
    CT scan of bilateral hydronephrotic kidneys withouCT scan of bilateral hydronephrotic kidneys without intravenous contrast medium.
    CT scan with dilated right ureter without intravenCT scan with dilated right ureter without intravenous contrast medium.
Contributor Information and Disclosures

Stefan H Hautmann, MD, PhD Professor of Urology, Director, Department of Urology and Pediatric Urology, Luedenscheid Hospital, Academic Hospital of the University of Bonn, Germany

Disclosure: Nothing to disclose.


Raymond J Leveillee, MD, FRCS(Glasg) Professor of Clinical Urology, Radiology and Biomedical Engineering, Department of Urology, University of Miami Miller School of Medicine; Chief, Division of Endourology/Laparoscopy and Minimally Invasive Surgery, Department of Urology, Jackson Memorial Hospital

Raymond J Leveillee, MD, FRCS(Glasg) is a member of the following medical societies: American Urological Association, Endourological Society, Sigma Xi, Society of Laparoendoscopic Surgeons

Disclosure: Received honoraria from ACMI/Gyrus for speaking and teaching; Received honoraria from Boston Scientific for speaking and teaching; Received honoraria from Applied Medical for speaking and teaching; Received honoraria from Intuitive Surgical for speaking and teaching; Received grant/research funds from Intio for other.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Shlomo Raz, MD Professor, Department of Surgery, Division of Urology, University of California, Los Angeles, David Geffen School of Medicine

Shlomo Raz, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, California Medical Association

Disclosure: Nothing to disclose.

Chief Editor

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, Society of Laparoendoscopic Surgeons, Society of University Urologists, Association of Military Osteopathic Physicians and Surgeons, American Urological Association, Endourological Society

Disclosure: Nothing to disclose.

Additional Contributors

Raymond R Rackley, MD Professor of Surgery, Cleveland Clinic Lerner College of Medicine; Staff Physician, Center for Neurourology, Female Pelvic Health and Female Reconstructive Surgery, Glickman Urological Institute, Cleveland Clinic, Beachwood Family Health Center, and Willoughby Hills Family Health Center; Director, The Urothelial Biology Laboratory, Lerner Research Institute, Cleveland Clinic

Raymond R Rackley, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

  1. Goodwin WE, Casey WC, Woolf W. Percutaneous trocar (needle) nephrostomy in hydronephrosis. J Am Med Assoc. 1955 Mar 12. 157(11):891-4. [Medline].

  2. Fernström I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol. 1976. 10(3):257-9. [Medline].

  3. Alken P, Hutschenreiter G, Gunther R, et al. Percutaneous stone manipulation. J Urol. 1981 Apr. 125(4):463-6. [Medline].

  4. Parikh GP, Shah VR, Modi MP, Chauhan NC. The analgesic efficacy of peritubal infiltration of 0.25% bupivacaine in percutaneous nephrolithotomy - A prospective randomized study. J Anaesthesiol Clin Pharmacol. 2011 Oct. 27(4):481-4. [Medline]. [Full Text].

  5. 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].

  6. Li CC, Li JR, Huang LH, Hung SW, Yang CK, Wang SS, et al. Metallic stent in the treatment of ureteral obstruction: Experience of single institute. J Chin Med Assoc. 2011 Oct. 74(10):460-3. [Medline].

  7. Deshmukh S, Sternberg K, Hernandez N, Eisner BH. Compliance with American Urological Association Guidelines for Post-Percutaneous Nephrolithotomy Antibiotics Does Not Appear to Increase Rates of Infection. J Urol. 2015 Oct. 194 (4):992-6. [Medline].

  8. Viers BR, Cockerill PA, Mehta RA, Bergstralh EJ, Krambeck AE. Extended antimicrobial use in patients undergoing percutaneous nephrolithotomy and associated antibiotic related complications. J Urol. 2014 Dec. 192 (6):1667-72. [Medline].

  9. Bayne D, Taylor ER, Hampson L, Chi T, Stoller ML. Determinants of nephrostomy tube dislodgment after percutaneous nephrolithotomy. J Endourol. 2015 Mar. 29 (3):289-92. [Medline].

  10. Biyani CS, O'Connor JP, Browning AJ. Laparoscopic removal of retained nephrostomy tubing. J Urol. 2003 Sep. 170(3):916-7. [Medline].

  11. Bloom DA, Morgan RJ, Scardino PL. Thomas Hillier and percutaneous nephrostomy. Urology. 1989 Apr. 33(4):346-50. [Medline].

  12. Carson CC, Little N. The absolute and relative contraindications to ESWL. Problems in Urology. Philadelphia, Pa: JB Lippincott Co; 1987. Vol 1: 580.

  13. Clayman RV, Kavoussi LR. Endosurgical techniques for noncalculous disease. Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders Co; 1992. 2235-45.

  14. Coleman CC, Kimura Y, Reddy P. Complications of nephrostolithotomy. Sem Intervent Radiol. 1984. 1:24.

  15. Grasso M, Loisides P, Beaghler M, et al. The case for primary endoscopic management of upper urinary tract calculi: I. A critical review of 121 extracorporeal shock-wave lithotripsy failures. Urology. 1995 Mar. 45(3):363-71. [Medline].

  16. Grasso MG, Taylor F. Techniques for percutaneous renal access. Sosa RE, Albala DM, eds. Textbook of Endourology. Philadelphia, Pa: WB Saunders Co; 1996.

  17. Kaskarelis IS, Papadaki MG, Malliaraki NE, et al. Complications of percutaneous nephrostomy, percutaneous insertion of ureteral endoprosthesis, and replacement procedures. Cardiovasc Intervent Radiol. 2001 Jul-Aug. 24(4):224-8. [Medline].

  18. Kavanagh DO, Fanning N, Heffernan E, et al. Management of gestational nephrolithiasis in the presence of a bicornuate uterus and pelvic kidney. Int J Urol. 2005 Feb. 12(2):211-3. [Medline].

  19. Kukreja R, Desai M, Patel S, et al. Factors affecting blood loss during percutaneous nephrolithotomy: prospective study. J Endourol. 2004 Oct. 18(8):715-22. [Medline].

  20. Lam HS, Lingeman JE, Mosbaugh PG, et al. Evolution of the technique of combination therapy for staghorn calculi: a decreasing role for extracorporeal shock wave lithotripsy. J Urol. 1992 Sep. 148(3 Pt 2):1058-62. [Medline].

  21. LeRoy AJ, Williams HJ Jr, Bender CE, et al. Colon perforation following percutaneous nephrostomy and renal calculus removal. Radiology. 1985 Apr. 155(1):83-5. [Medline].

  22. Little B, Ho KJ, Gawley S, et al. Use of nephrostomy tubes in ureteric obstruction from incurable malignancy. Int J Clin Pract. 2003 Apr. 57(3):180-1. [Medline].

  23. Mariappan P, Smith G, Bariol SV, et al. Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study. J Urol. 2005 May. 173(5):1610-4. [Medline].

  24. Motola JA, Smith AD. Therapeutic options for the management of upper tract calculi. Urol Clin North Am. 1990 Feb. 17(1):191-206. [Medline].

  25. Picus D, Weyman PJ, Clayman RV, et al. Intercostal-space nephrostomy for percutaneous stone removal. AJR Am J Roentgenol. 1986 Aug. 147(2):393-7. [Medline].

  26. Segura JW. Percutaneous management. Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders; 1992. 2183-94.

  27. Segura JW, Preminger GM, Assimos DG, et al. Nephrolithiasis Clinical Guidelines Panel summary report on the management of staghorn calculi. The American Urological Association Nephrolithiasis Clinical Guidelines Panel. J Urol. 1994 Jun. 151(6):1648-51. [Medline].

  28. Smith AD. Management of iatrogenic ureteral strictures after urological procedures. J Urol. 1988 Dec. 140(6):1372-4. [Medline].

  29. Strohmaier WL, Giese A. Ex vivo training model for percutaneous renal surgery. Urol Res. 2005 Jun. 33(3):191-3. [Medline].

  30. Tanaka T, Yanase M, Takatsuka K. Clinical course in patients with percutaneous nephrostomy for hydronephrosis associated with advanced cancer. Hinyokika Kiyo. 2004 Jul. 50(7):457-62. [Medline].

  31. Whitaker RH. An evaluation of 170 diagnostic pressure flow studies of the upper urinary tract. J Urol. 1979 May. 121(5):602-4. [Medline].

  32. Zagoria RJ, Dyer RB. Do's and don't's of percutaneous nephrostomy. Acad Radiol. 1999 Jun. 6(6):370-7. [Medline].

Renal anatomy.
Positioning of nephrostomy tube into the lower pole of the kidney.
Outside appearance of a nephrostomy tube from the flank after stone removal.
CT scan of bilateral hydronephrotic kidneys without intravenous contrast medium.
CT scan with dilated right ureter without intravenous contrast medium.
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