nefrostomi

Nephrostomy, or nefrostomi in some languages, is a medical procedure that creates a direct urinary drainage route from the kidney to the skin surface. A catheter is placed into the renal collecting system through a small flank incision to allow urine to drain externally, bypassing an obstructed ureter or bladder. It can be performed temporarily to relieve obstruction or infection or permanently when ongoing drainage is required.

Most nephrostomies are percutaneous and guided by ultrasound or CT and/or fluoroscopy. The procedure is typically done under local anesthesia with sedation. A clinician punctures the renal pelvis, advances a guidewire, dilates the tract, and inserts a nephrostomy catheter. The catheter channels urine from the kidney to an external collection bag. Catheter size and design vary; some have multiple side holes and may be anchored to the skin or subcutaneous tissue. Antibiotic prophylaxis is commonly used.

Indications include relief of obstructive uropathy due to stones, tumors, or ureteral strictures; drainage of hydronephrosis with infection or sepsis; preoperative decompression; and urinary diversion when bladder drainage is not feasible or desired. It may be employed as a bridge to definitive treatment or as palliative management in malignant or end-stage conditions.

Care and complications: catheter care includes monitoring urine output, preventing occlusion, and keeping the insertion site clean and dry. Potential complications are bleeding, infection, catheter dislodgement or blockage, urinoma, and injury to adjacent organs. Nephrostomy is generally effective for temporary relief and can be long-term when indicated by the underlying condition.