pyelostomy

Pyelostomy is a surgical procedure that creates an opening in the renal pelvis to allow urine to drain externally. The opening, or ostomy, may be temporary or permanent and can be established by open surgery or by a percutaneous technique. It is used when drainage of the renal collecting system is needed but internal passage into the bladder is not feasible or desirable.

Indications include obstructive uropathy from stones or edema, post-traumatic or iatrogenic injury to the ureter or pelvis, severe hydronephrosis, infection with sepsis from obstructed kidney, or as a temporary urinary diversion in patients awaiting definitive treatment, including after renal transplantation or complex pelvic surgery.

Open pyelostomy involves exposing the renal pelvis through a flank or loin incision and creating an ostomy with a catheter exiting through the abdominal wall. Percutaneous pyelostomy uses image-guided puncture to access the renal pelvis and placement of a drainage catheter that exits through the skin. In either approach, the device provides external drainage and may be connected to a collection bag; the stoma is typically matured to a stable opening and secured with sutures.

Postoperative considerations include monitoring drainage, managing infection, ensuring catheter patency, and preventing skin irritation around the stoma. Complications can include bleeding, urinary leakage, infection, catheter dislodgement or occlusion, urinoma, fistula formation, or stenosis of the ostomy.

Pyelostomy is one option among urinary diversion techniques, with alternatives including nephrostomy tubes, ureteral stents, ureterostomies, or definitive reconstruction depending on the underlying cause and patient condition.