nephrostomies

A nephrostomy is a medical procedure that creates a direct opening from the kidney to the skin to allow urine to drain externally. The most common form is percutaneous nephrostomy (PCN), in which a catheter is inserted through the flank into the renal collecting system under image guidance. Nephrostomies can be temporary or long-term and are used to relieve urinary obstruction, drain infected urine, or serve as a conduit during treatment planning or surgery.

Indications include obstructive uropathy from kidney stones, malignant obstruction, ureteral strictures, or post-surgical edema; hydronephrosis with infection or sepsis; and preoperative decompression. They may also provide access for antegrade procedures or for urinary diversion when other routes are unsuitable. The choice between a single or multiple nephrostomy tracts depends on the underlying problem and drainage requirements.

Technique and care: the procedure is typically performed under local anesthesia with sedation, using ultrasound or CT guidance. A needle punctures the renal collecting system, a guidewire is passed, the tract is dilated, and a nephrostomy catheter is positioned to drain externally into a collection bag. Catheters may be a single or double lumen and are secured to the skin. Care includes maintaining catheter patency, sterile dressing, monitoring drainage, and preventing dislodgement or kinking. Removal is considered when the obstruction is resolved or alternative drainage is possible.

Complications are uncommon but can include bleeding, infection, catheter dislodgement or blockage, urine leakage, and injury to surrounding structures. Long-term nephrostomies may require periodic catheter changes and imaging follow-up. Alternatives include ureteral stenting or surgical repair, depending on the cause of obstruction and patient condition.