Percutaneous nephrostomy: technical aspects and indications - PubMed (original) (raw)

Percutaneous nephrostomy: technical aspects and indications

Mandeep Dagli et al. Semin Intervent Radiol. 2011 Dec.

Abstract

First described in 1955 by Goodwin et al as a minimally invasive treatment for urinary obstruction causing marked hydronephrosis, percutaneous nephrostomy (PCN) placement quickly found use in a wide variety of clinical indications in both dilated and nondilated systems. Although the advancement of modern endourological techniques has led to a decline in the indications for primary nephrostomy placement, PCNs still play an important role in the treatment of multiple urologic conditions. In this article, the indications, placement, and postprocedure management of percutaneous nephrostomy drainage are described.

Keywords: Nephrostomy; hydronephrosis; interventional radiology; kidney; nephroureterostomy.

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Figures

Figure 1

Figure 1

Left pelvic ureteral injury during hysterectomy managed by retrograde ureteral stenting. (A) A 55-year-old woman, 4 weeks postvaginal hysterectomy, with vaginal leakage of urine. Left retrograde ureterogram demonstrates extravasation from the left pelvic ureter. (B) Internalized double pigtail ureteral stent was successfully placed with cystoscopic guidance. (C) Six weeks later, retrograde ureterogram shows complete healing of the ureter. Subsequent imaging showed no stricture or obstruction.

Figure 2

Figure 2

Anastomotic stricture at left uretero-ileal anastomosis in a 62-year-old man. (A) Loopogram demonstrates free reflux into the right ureter and collecting system, which are normal in appearance. There is no reflux into the left ureter, which is highly suspicious for an anastomotic stricture. These tend to be related to benign fibrosis and are not usually related to urothelial tumor recurrence. (B) A computed tomography (CT) scan demonstrates left hydronephrosis. Other images demonstrated ureteral dilation to the ureteroileal anastomosis. The patient underwent left percutaneous nephrostomy and balloon dilation of the anastomotic stricture.

Figure 3

Figure 3

Patient with ureteropelvic junction obstruction underwent percutaneous nephrostomy (PCN) for planned percutaneous endopyelotomy. CO2 was injected through a retrograde ureteral catheter (not shown). Because the patient was prone, the CO2 rose to delineate the posterior calyces. An interpolar calyx was subsequently punctured.

Figure 4

Figure 4

Nephrocolic fistula following percutaneous nephrolithotomy (PCNL). Nephrostogram through a nephrostomy catheter after PCNL for a large staghorn calculus demonstrates opacification of the ascending colon through the nephrostomy track. The patient was asymptomatic. The fistula was managed conservatively: the patient was placed on a low residue diet, a double pigtail internalized stent was placed, and the nephrostomy catheter was retracted into the perinephric space. The fistula closed in 10 days.

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