Urology

Nephrostomy Treatment

Opening created between kidney and skin

Urine normally drains from your kidneys into your bladder through small muscular tubes called ureters. Sometimes one or both of your ureters can become blocked. A nephrostomy is a procedure to drain urine from your kidney using a catheter (tube).

Overview

Humans have two kidneys, where urine is made; each of these kidneys passes urine to the bladder by a tube called the ureter. This tube can become blocked for a number of reasons; these reasons may include kidney stones or cancer. A blocked ureter can stop the kidney from working properly and can even damage the kidney. Also, if the urine that is blocked becomes infected, it can cause damage.

A nephrostomy is a passage between the kidney and the skin. A nephrostomy tube is a thin plastic tube that is passed from the back of the body, through the skin and then through the kidney, to the point where the urine collects. Its job is to temporarily unload the urine that is blocked. This allows the kidney to function properly and protects it from further damage and thus helps in clearing any infection.

Ultrasound and/or X-ray images (or pictures) are used to guide the procedure. Contrast is injected into the part of the kidney that collects the urine. This enables the tube that will drain the kidney to be inserted into the collecting system in the best position.

What is Nephrostomy?

The kidneys produce urine. Urine drains through the ureters into the bladder. It then passes through the urethra and leaves the body. Sometimes cancer in the lower abdomen can block one or both of the ureters. When this happens, urine can’t leave the kidney. This causes damage.

A nephrostomy allows the urine to pass through a tube. The tube is inserted through the skin on the back and into the kidney. With the help of x-ray or ultrasound, the doctor determines the best place in the kidney to place the tube. The doctor numbs the patient’s back with the help of local anesthetic and inserts a fine guide-wire into the kidney, which helps the doctor place the nephrostomy tube correctly. Stitches or dressings hold the tube securely in its place. The tube is connected to a urine collection bag which can be easily worn under the clothing. Some people will need the nephrostomy for a short time; others may require it for permanently.

A nephrostomy is an artificial opening created between the kidney and the skin which allows the diversion of the urine directly from the upper part of the urinary system.

Why Nephrostomy?

A nephrostomy is performed whenever there is a blockage that keeps urine from passing the kidneys, through the ureter and into the urinary bladder. Without any other way for urine to pass, pressure would rise within the urinary system and thus results in damage of kidneys.

The most common cause of blockage is cancer, especially ovarian cancer and colon cancer.Page Image

Nephrostomy may also be required to treat pyonephrosis, hydronephrosis, and kidney stones. Nephrostomy can help in the removal of renal calculi; it helps in obtaining direct access to the upper urinary tract for various endourologic procedures. Nephrostomy can help in diagnosing ureteral obstruction, filling defects, and anomalies via antegrade radiography, for delivering chemotherapeutic agents to the renal collecting system. Nephrostomy provides prophylaxis after resection for local chemotherapy in patients with tumors of the renal pelvis.

Procedure

A nephrostomy tube is usually put in under local anesthetic during a short stay in the hospital. A doctor who specializes in using x-rays and scans performs the procedure. It is usually performed in the x-ray department. The doctor places the nephrostomy tube in the kidney with the help of x-ray or ultrasound scanning. It can usually take up to 30- 60 minutes.

The doctor or nurse may put a fine tube into a vein in the patient’s arm. Sometimes a drip is attached to the cannula to supply fluids. Antibiotics are given to the body through the cannula to reduce the risk of getting an infection.

The patient will be asked to lay flat on his/her stomach on an x-ray table. The doctor will inject some local anesthetic into the skin on the patient’s back. When the area is numb, the doctor inserts a fine needle into the kidney; they put a guide-wire through the needle. The doctor uses the guide-wire to place the nephrostomy tube in the correct position in the kidney. The tube is kept in its place with stitches or dressings. It may also consist of a locking system to keep it in place. The doctor will connect the tube to a bag outside the body for collection of urine.

Nephrostomies are created by surgeons and typically consist of a catheter which pierces the skin and rests in the urinary tract. It is performed under CT fluoroscopy, ultrasound guidance or under image intensifier. The Area is made numb with the help of local anesthetic, where the needle would make a puncture on the kidney.

Newer technologies such as 3D fluoroscopy are being developed to help in the placement of these types of drainage tubes. Urine is collected in an external bag connected to the tube, which can be emptied as often as necessary. The doctor will explain the duration for which the patient needs to keep the nephrostomy tube. It may be removed if treatment for cancer clears the blockage. Sometimes a small tube called a stent is put through the blockage in the ureter if the stent clears the blockage; the nephrostomy tube can be removed. If cancer treatment or a stent does not clear the blockage, the nephrostomy will be left inside.

What are the Risks involved?

There are a few recognized risks associated with a nephrostomy. Inserting a nephrostomy is a safe procedure and the risk of serious complication is rare.

But the risks include:

  • Severe bleeding (hemorrhage): 1–3%,
  • Tube dislodgement: 1% ,
  • Tube blockage: 1%,
  • Serious infection: 1%,
  • Damage to adjacent structures: rare,
  • Vascular injury requiring removal of the affected kidney or embolization 1% – 3.6%,
  • Death due to hemorrhage: less than 0.2%;
  • Allergic reaction to contrast injection – severe reactions occurs in less than 1 in every 1000 patients.

                                        

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