Interventional Ultrasound: Positioning Nephrostomy
Percutaneous nephrostomy is a mini-invasive method that creates a communication between the renal excretory tract and the outside, through a catheter with its outlet in the flank. The first attempts were made by Goodwin in 1955, but of course they were bl
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Pasquale Martino, Carlos Miacola, Michele Barbera, and Silvano Palazzo
14.1 Indications The indications for positioning a percutaneous nephrostomy are both diagnostic (e.g., descending pyelography) and therapeutic, when an immediate decompression of the upper urinary tract is needed and the transureteral approach is impossible, not indicated, or likely to fail [1, 2]. Indications of an urgent nature include postrenal obstruction with urosepsis (and/or uremia) and postoperative (or traumatic) urinoma. The approach is particularly useful in the course of pyonephrosis, when antibiotic treatment alone may not be efficacious due to obstruction of the collector ducts. In such cases, a rapid decompression of the obstructed system is obtained, thereby reducing the risk of urosepsis.
Electronic supplementary material The online version of this chapter (doi:10.1007/978-3-319-40782-1_14) contains supplementary material, which is available to authorized users. P. Martino (*) • C. Miacola • S. Palazzo Department of Emergency and Organ Transplantation – Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy e-mail: [email protected]; [email protected]; [email protected]
Nonurgent (or elective) indications include: • Temporary drainage after urological treatment or during radiotherapy (or radiochemotherapy) for neoplastic-type obstructions • Palliative drainage in patients with cancers causing ab-extrinsic compression of the ureters (e.g., invasive prostate cancer, bladder sarcoma, squamous carcinoma, cancer of the uterus and ovaries, retroperitoneal fibrosis) • Temporary drainage in the treatment of urinary fistulas [3, 4] The procedure may also be useful when instilling chemotherapeutic drugs, even if this is a rare indication. Percutaneous nephrostomy may be the important first step in surgical procedures like the extraction of urinary stones, percutaneous lithotripsy, the removal of foreign bodies, excision of urothelial cancers, and the treatment of renal cysts and calyceal diverticuli, in antegrade positioning of double J stents, in the access for endoscopic correction of stenosis of the pyeloureteral junction.
M. Barbera U.O. Urologia – Presidio Ospedaliero di Sciacca – Asp Agrigento, Agrigento, Italy © Springer International Publishing Switzerland 2017 P. Martino, A.B. Galosi (eds.), Atlas of Ultrasonography in Urology, Andrology, and Nephrology, DOI 10.1007/978-3-319-40782-1_14
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14.2 Preparation Positioning a percutaneous nephrostomy is numbered among surgical maneuvers, and as such, it is important to observe some precautions. It is necessary to verify blood count and clotting and to monitor arterial pressure and heart rate. It is advisable to administer antibiotic prophylaxis and to be able to rely on a venous access (so as to be able to administer catecholamines and/or anticholinergics if necessary). The nephrostomic access will be posterior or posterolateral, owing to the relationships of the kidney with the adjacent organs. The liver and splee
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