Percutaneous Nephrostomy insertion

Percutaneous nephrostomy insertion is a minimally invasive procedure used to create a temporary or permanent opening (nephrostomy tract) from the kidney to the skin surface. This allows urine to drain directly from the kidney when the normal urinary pathway is obstructed, typically due to conditions such as kidney stones, tumors, or ureteral strictures. 

Indications

Percutaneous nephrostomy insertion is indicated for patients with:

1. Obstructive Uropathy: Blockage of the urinary tract, such as kidney stones, tumours, or ureteral strictures, leading to impaired kidney function or hydronephrosis (fluid buildup in the kidney).
2. Urinary Diversion: Temporary or permanent diversion of urine from the kidney when the normal pathway (ureter) is compromised or non-functional.
3. Diagnostic or Therapeutic Drainage: To obtain urine samples for analysis or to relieve pressure and prevent kidney damage in cases of severe hydronephrosis.

Procedure

1. Pre-procedure Assessment:
   • Imaging Studies: CT scans, ultrasounds, or intravenous pyelograms (IVPs) are used to assess the location and extent of the urinary obstruction.
   • Laboratory Tests: Blood tests, renal function tests, and urine analyses to evaluate kidney function and overall health.
2. Preparation:
   • Informed Consent: Explanation of the procedure, its risks, benefits, and alternatives, followed by obtaining informed consent from the patient.
   • Patient Preparation: The patient may be instructed to fast for several hours before the procedure.
3. Anaesthesia:
   • Local anaesthesia is typically used to numb the skin and tissues around the insertion site.
4. Insertion Technique:
   • The patient is positioned appropriately, usually lying on their front or side with the affected kidney facing upward.
   • Using ultrasound or fluoroscopic guidance, a thin needle is inserted through the skin and into the kidney (renal parenchyma).
   • A guide wire is then advanced through the needle and into the collecting system of the kidney under imaging guidance.
5. Dilation and Catheter Placement:
   • Over the guide wire, a series of dilators of increasing size are passed to create a tract from the skin to the kidney.
   • A nephrostomy catheter or tube is then inserted through the dilated tract and into the kidney’s collecting system, allowing urine to drain externally.
6. Confirmation and Securing the Catheter:
   • Placement of the nephrostomy catheter is confirmed using imaging (X-ray or fluoroscopy) to ensure proper positioning within the kidney.
   • The catheter is secured to the skin using sutures or adhesive dressings to prevent displacement.
7. Post-procedure Care:
   • The nephrostomy catheter is connected to a drainage bag to collect urine.
   • The insertion site is dressed and monitored for any signs of infection or complications.
   • Patients are given instructions on catheter care, hygiene, and follow-up appointments.

Benefits

• Urinary Drainage: Relieves pressure on the kidney and allows urine to bypass obstructed or damaged areas of the urinary tract.
• Kidney Function Preservation: Prevents kidney damage and preserves renal function in cases of severe hydronephrosis or obstructive uropathy.
• Diagnostic Access: Provides a route for obtaining urine samples directly from the kidney for analysis.
• Pain Relief: Alleviates symptoms such as flank pain and discomfort associated with obstructive uropathy.

Risks and Considerations

• Bleeding: Risk of bleeding during the procedure, particularly if there are underlying bleeding disorders or anticoagulant medications.
• Infection: Potential for infection at the insertion site or within the kidney, requiring monitoring and appropriate antibiotic therapy.
• Displacement or Blockage: The nephrostomy catheter may become displaced or blocked, necessitating repositioning or replacement.
• Perforation: Rarely, there may be a risk of injury or perforation of surrounding organs or tissues during catheter insertion.

Conclusion

Percutaneous nephrostomy insertion is a valuable procedure for managing obstructive uropathy and providing urinary drainage in cases of severe hydronephrosis or non-functional urinary pathways. By creating a temporary or permanent opening from the kidney to the skin surface, this procedure helps relieve symptoms, preserve kidney function, and allow for diagnostic access when needed. Close monitoring and follow-up care are essential to ensure the proper functioning of the nephrostomy catheter and to address any potential complications.