Nephrostomy Open

Nephrostomy open surgery

Open nephrostomy is a surgery in which a wound is made in the side of the body and an opening created in the kidney through that wound (to the renal pelvis) in order to provide an urine drainage route. A tube (nephrostomy tube) is inserted directly into the renal pelvis to bypass an obstruction in the urinary tract. 

What is Open Nephrostomy?

Open nephrostomy is a conventional operative procedure of kidney drainage that is normally undertaken in case of:

• Percutaneous (needle based) nephrostomy cannot be done.
• Cases are complicated anatomical abnormalities.
• The patient already receives open kidney surgery.
• Minimally invasive access is not possible in case of severe infection, scarring, or stones.

Indications of Open Nephrostomy

Obstructive uropathy due to:

• Large kidney stones
• Tumors (kidney, ureter, pelvic)
• Severe ureteric strictures
• Congenital malformations of the urinary tract
• Percutaneous nephrostomy failed or was contraindicated
• Purulent renal infection 
• Urinary tract traumatic injury.

Advantages

• Kidney structures could be observed directly.
• Applicable in complicated or unsuccessful instances of minimal invasions.
• May be used in conjunction with other renal procedures that are open.

Open nephrostomy procedure

Open nephrostomy is a surgery procedure through which a direct path to drainage is established between the kidney and the external body in case the urine flow is obstructed and an intervention based on minimum invasiveness could not be applied.

Procedure:

Preparation before Surgery

• Thorough clinical assessment and imaging (USG, CT-scan, IVU) 
• Blood tests, urine culture, tests of kidney functions.
• Therapy of any active infection by antibiotics.
• 6-8 hours starvation before surgery.
• Informed consent on risks and benefits.

Anaesthesia

• Carried out when under general anaesthesia.
• The patient is totally unconscious and pain-free throughout the surgery.

Patient Positioning

• Lateral (flank) positioning of the patient.
• It is placed with the side affected kidney upwards so that it can be accessed effectively.

Surgical Incision

• There is a flank incision below the rib margin.
• Layers of muscles are sharply cut to reveal the kidney.
• The kidney is moved in a gentle manner.

Access to Renal Pelvis

• The renal pelvis (urine-collected section of the kidney) is diagnosed.
• A minor incision controlled is performed on the renal pelvis.
• Any infected urine or pus is emptied out.

Placement of the Nephrostomy Tube 

• A sterile nephrostomy tube is inserted into the renal pelvis. 
• The urine flow verifies correct positioning.
• Sutures are used to fix the tube in case it gets out of position.

Drainage System Connection

• The tube is attached to an external bag of urine drainage.
• There is free and intermittent urine flow.

Wound Closure

• The tube is surrounded with the incision of renal pelvis.
• There is suture on the muscles and skin layers.
• Sterile dressing is applied

Duration of Surgery

• Normally 60-120 minutes, based on complexity.

Postoperative Care

• Urine results and vital signs monitoring.
• Analgesics and antibiotics.
• Flushing of nephrostomy tube regularly when necessary.
• Wound management and dressing.
• When required, imaging to establish tube position.

Nephrostomy open complications

Open nephrostomy is a good surgical intervention to drain kidneys, just as any other major surgery; it has possible risks and complications. This can be in the course of surgery, right after surgery or later.

Complications during Surgery

• Bleeding
• Injury to surrounding organs
• Complications associated with anaesthesia

Early post-operative complications 

• Hemorrhage
• Infection
• Urine leakage
• Pain and discomfort
• Wound complications

Complications associated with Tube

• Tube blockage
• Tube displacement
• Leakage around the tube site
• Skin irritation

Late Complications

• Persistent urinary fistula
• Stricture formation
• Recurrent infection
• Scar formation
• Reduced kidney function

Open nephrostomy recovery

The success of open nephrostomy surgery is slow and it has to be closely monitored because of the invasive process. Healing time depends on the general health of the patient, kidney disease and infection.

Recovery Following Surgery (First 24-72 hours) 

• Strict surveillance in the hospital.
• Treatment of pain by intravenous and oral drugs.
• Sustained monitoring of urine discharge via nephrostomy tube.
• To prevent or treat infection antibiotics.
• IV-fluids to keep body hydrated.
• Early light exercises to avoid complications such as blood clots.

Hospital Stay

• Average duration: 5–7 days
• Inspection of wounds and coating of wounds daily.
• Following up the kidney tests and electrolytes.
• Nephrostomy tube position and functionality.
• Pre-discharge tube education to patients.

Nephrostomy Tube Care in Recovery

• The drainage bag should be kept below the kidneys.
• Make sure that the tube is neither kinked nor pulled.
• Drain the urine bag every now and then and keep the hygiene.
• Monitor urine output (reduced, painful) and pain.
• Tube flushing not unless the doctor recommends it.

Pain and Wound Healing

• Pain of flank incision is frequent and slowly fades away in 2-3 weeks.
• Sutures or staples tend to be taken off in 7-14 days.
• The incision should have mild swelling or bruising.

Activity and Lifestyle

• After 2-3 weeks light activities may be resumed.
• No heavy lifting, hard work or bending in 4-6 weeks.
• Healing requires adequate rest.
• Be well hydrated unless limited by your physician.

Diet During Recovery

• Begin with easy to digest food.
• Advance to normal diet as tolerated.
• Wound healing is favored by protein containing diets.
• Follow kidney-specific dietary guidelines. 

Open surgical nephrostomy

Open surgical nephrostomy is an operation that is performed in traditional urology where the kidney is surgically opened with an opening through the flank into the renal pelvis. It enables the urine to pass outwardly through the blocked urinary tract when the less invasive procedure is inappropriate.

What is Open Surgical Nephrostomy?

It is a direct drainage of the kidney which is carried out under general anaesthesia. It is no longer frequently used because of the percutaneous methods, but is still significant in complicated, emergency, or failed minimally invasive cases.

Indications

Open surgical nephrostomy is indicated following:

• Percutaneous nephrostomy is either contraindicated or unsuccessful.
• Severe ureteric obstruction 
• Infected and pus-filled renal pelvis
• Urinary tract abnormalities congenital or complex.
• Extensive scarring of the past surgeries.
• Open renal surgery is intended to be performed.

Open Surgical Nephrostomy Procedure

• General anaesthesia is performed.
• Lateral (flank) position of the patient.
• Incision on the neck of the kidney.
• Renal pelvis was identified and opened.
• Nephrostomy tube implanted in the renal pelvis.
• Secured and attached tube to drainage bag.
• Wound closed in layers
• Time of day: Morning or evening.

Best hospital Open nephrostomy India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Open surgical nephrostomy is a time-reliable and valid operation to remove obstruction in the urinary tract in cases where the minimal invasive surgeries are not viable or have failed. Although it is much more invasive and recovering longer with complications, proper patient selection, a careful surgical procedure, and adequate aftercare also help a great deal. Open nephrostomy is an effective intervention to help in saving kidney performance, managing infection, and as a valuable transitional measure of ultimate urological therapy.

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FAQ

1. When is open nephrostomy indicated instead of percutaneous nephrostomy?

• It is indicated when percutaneous access is unsuccessful or hazardous because of anatomical reasons, presence of severe infection, and presence of dense adhesive from previous surgical procedures or if open nephrectomy or open stone removal is required.

2. Is open surgical nephrostomy a major surgery?

• Yes. Because of a large incision and direct access to the kidney under general anesthesia, it is regarded as a major surgical procedure.

3. Is the nephrostomy tube permanent?

• Most of the time the tube is temporary and gets removed after the obstruction is relieved and normal flow of urine is re-established. It may stay longer in chronic situations.

4. Do you know if open nephrostomy procedure hurt?

• Postoperative pain is anticipated due to the incision and it is usually well managed with medications.

5. Will kidney function improve after open nephrostomy?

• Kidney function improves after obstruction is relieved, particularly if done early.