nephrostomy

Nephrostomy is a medical procedure that creates an opening between the skin and the kidney to drain urine. A nephrostomy catheter or tube is placed through the skin into the renal collecting system, allowing urine to exit externally into a collection bag. Nephrostomy can be temporary or long-term. The most common form is percutaneous nephrostomy, carried out under image guidance (ultrasound or fluoroscopy) by interventional radiology, though surgical nephrostomy can be performed via open or laparoscopic approaches.

Indications for nephrostomy include relief of urinary obstruction from stones, tumors, strictures, or edema; drainage of a blocked or infected kidney; urinary diversion when ureteral access is not feasible; and providing access for further procedures such as stone removal or diagnostic evaluation. It may also be used after injury to the urinary tract or during certain urological surgeries.

Procedure overview includes puncturing the renal collecting system with imaging guidance, inserting a guidewire, dilating the tract, and placing a nephrostomy catheter that drains externally. The catheter is secured to the skin and connected to a drainage bag. The patient is usually treated with local anesthesia and sedation, and post-procedure imaging confirms catheter position and drainage adequacy.

Care and complications: potential issues include bleeding, infection, catheter dislodgement or blockage, urine leakage, and injury to surrounding structures. Contraindications include uncorrected coagulopathy, active infection at the puncture site, or unfavorable anatomy that precludes safe access.

Outcomes and alternatives: nephrostomy provides immediate urinary drainage and can relieve hydronephrosis, preserving kidney function in selected cases. Alternatives include ureteral stenting or definitive treatment of the underlying obstruction, such as stone removal or surgical correction.