Background
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. [5] 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
Indications for percutaneous nephrostomy include the following:
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Urinary diversion:
Urinary obstruction secondary to calculi
Urinary fistula and/or leaks, eg, 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, eg, abscess, urinoma
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Access to the collecting system:
For interventions, eg, direct infusion of substances for dissolving stones, chemotherapy, and antibiotic and antifungal therapy
For endourological procedures, eg, stricture dilatation, antegrade ureteral stent placement, stone retrieval, pyeloureteroscopy, or endopyelotomy
Contraindications
Contraindications for percutaneous nephrostomy include the following:
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Bleeding diathesis (most commonly, uncontrollable coagulopathy)
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Uncooperative patient
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Uncontrolled hypertension [6]
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Percutaneous nephrostomy. Shown are two types of nephrostomy tubes: the Malecot (top) tube, and the pigtail catheter (bottom).
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Percutaneous nephrostomy. The needle is positioned in the mid-pole posterior calyx, filled with air. A filter in the inferior vena cava.
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A 0.018-inch guidewire has been advanced through the needle into the ureter.
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An 8F locking pigtail catheter has been placed in the renal pelvis.
