Index
Urine passes into the bladder through a tube called the ureter.
Definition: if this tube is blocked and does not correctly perform its function, it can cause damage to the kidneys, causing infections.
This tube can be blocked by the presence of kidney stones or cancer. If this happens, it is necessary to drain the blocked urine in the kidney.
There is a procedure called: Nephrostomy, which is nothing more than an opening between the kidney and the skin with the placement of a thin plastic tube, which is passed from the outside, through the skin, and then through the kidney, where it accumulates urine.
The contrast technique guides the procedure, and the process is driven by ultrasound and X-ray images.
Nephrostomy, in addition to helping to maintain kidney function and protect the kidney from infections, can help diagnose an underlying problem since the injection of contrast and the use of ultrasound and X-rays allow images of the ureter and observe any present anomaly.
Preparation for a nephrostomy
As in any surgery, the patient must remain fasting and inform his doctor about the following aspects:
- If you are using anticoagulant medications (for example, Warfarin) or have had excessive bleeding in previous surgeries
- If you suffer from any allergy to the components of any medication or contrast media
- If you have any symptoms of infection: fever, night sweats
- If you have any previous history of kidney disease or have had prior surgery on the kidney or bladder
- Also, take any x-rays, CT scans, ultrasound, or magnetic resonance imaging.
All this information reinforces the level of alert that medical personnel must have to plan the procedure and prevent complications.
Your treating doctor or the hospital where you will be tested will have the tests or exams you need before undergoing the nephrostomy.
Process
When you arrive at the hospital, be sure to ask any questions or express any questions or concerns you may have.
The doctor will inform you of all the procedure details, and additionally, you must complete a consent form.
Almost all nephrostomy tubes are inserted under sedation or general anesthesia.
The procedure is carried out on a unique X-ray stretcher, lying on your stomach or slightly on your side, which allows the radiologist to access your kidney.
An intravenous or “drip” cannula, a thin plastic tube, will be inserted into your hand or arm.
Your sedation and medications for pain relief will usually be injected.
If general anesthesia is not applied, a local anesthetic will be injected in the part where the nephrostomy tube is inserted; a small incision will be made in the skin.
The radiologist will use ultrasound and X-rays to guide a skinny needle through the skin to the correct position, confirmed using a contrast medium.
A wire is then placed through the needle, and the hand is removed.
This cable is the guide for the nephrostomy tube, which is inserted over the line, which will then be removed, then the box is “locked” in position by pulling a rope that causes the end to curve with the appearance of a ” pigtail, “which helps keep it in place.
The final placement is confirmed with a second injection of contrast medium and fixed to the surface with a combination of dressings, plastic clips, and stitches.
A drainage bag is connected to the nephrostomy tube to collect urine to complete the procedure.
The duration of the procedure may vary, depending on the internal structure of the patient’s body and the reason why the nephrostomy is performed.
However, a more extended procedure does not necessarily mean a complication has occurred.
The procedure’s success will be observed immediately after insertion. As long as the nephrostomy continues to drain urine, it will maintain renal function, and any infection that occurs can be treated with antibiotics.
Side effects and risks of a nephrostomy
This procedure can cause pain and bruise where the needle, cable, and tubes are inserted.
The urine will show blood residues, usually for 1 to 2 days.
If the pain or bleeding in the urine worsens, you should go immediately to the treating doctor to ensure that a complication has not arisen or infections have developed.
The insertion of a nephrostomy tube is a relatively safe procedure, and the risk of serious complications is unusual. The risks include:
- Severe bleeding (hemorrhage): 1-3%
- Detachment of the tube: 1%
- Blockage of the box: 1%
- Severe infection: 1%
- Damage to adjacent structures is minimal
- Avascular injury that requires the removal of the affected kidney or embolization 1% – 3.6%
- Death due to bleeding: less than 0.2%
- Allergic reaction to contrast injection, less than 1 in 1000 patients
