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A nephrostomy or percutaneous nephrostomy is an artificial opening created between the kidney and the skin which allows for the urinary diversion directly from the upper part of the urinary system (renal pelvis). It is an interventional radiology/surgical procedure in which the renal pelvis is punctured whilst using imaging as guidance. Images are obtained once an antegrade pyelogram (an injection of contrast), with a fine needle, has been performed. A nephrostomy tube may then be placed to allow drainage.
An urostomy is a related procedure performed more distally along the urinary system to provide urinary diversion.
The most common cause of blockage necessitating a nephrostomy is cancer, especially ovarian cancer and colon cancer. Nephrostomies may also be required to treat pyonephrosis, hydronephrosis and nephrolithiasis.
Percutaneous nephrostomy is also used to provide access for chemotherapy/antibiotic/antifungal therapy, antegrade urethral stent placement, stone retrieval, and endopyelotomy (endoscopic surgery for the enlargement of the junction of renal pelvis and ureter).
may be placed during the procedure for patients who are expected to need long-term decompression of the renal system, such as those with malignant obstructions. A recent meta-analysis has shown that ureteral stenting is a safe alternative to traditional percutaneous nephrostomy. Stenting may help to improve patient quality of life by reducing need for frequent tube exchanges and a lower risk of tube displacement.
Under interventional radiology, the subject either lies down on the side or in a prone position. An area is selected below the 12th rib, bounded laterally by the posterior axillary line and the muscles of the spine and from below by the pelvic bone. The exact area is then located by ultrasound. Local anesthetic infiltration is used to numb the area. Then a needle would pass through to make the puncture on the kidney. Then, urine from the kidney is aspirated and check for its contents. If the urine is clear, dye will be injected to delineate the renal pelvis and renal calyx. If the urine is turbid, it means the urine is infected. Dye injection is avoided in case of turbid urine to prevent the spread of infection to other parts of the urinary system. Then, a guidewire is inserted into the through the needle and parked within the upper renal calyx or within the ureter under fluoroscopy guidance. Then the puncture tract is dilated using a dilator. Various types of catheters such as pigtail catheter or Malecot catheter (a catheter that has a special mechanism for preventing blockage in case of thick pus in pyonephrosis and not easily dislodged when compared to pigtail catheter) can be used. The catheter is inserted through the guidewire and is secured in place by suturing it to the skin. The other end of the catheter is attached to a urine bag for drainage of urine from the kidney.
Although pneumothorax and colonic injury are more common on subcostal needle insertion, these are rare complications.
Blood in urine usually clears up after 48 to 72 hours. Bleeding longer than this period may signifies more serious bleeding complication. About 2–4% of percutaneous nephrostomy cases require blood transfusion. Arteriovenous fistula is a rare complication.
The BMJ has published original research of this condition and its treatment,
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