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Percutaneous nephrostomy is overall a very safe procedure. [8] Risks and complications include: [8] Malposition; Intra-peritoneal leakage, causing ascites; Hemorrhage; Infection. This can generally be treated with antibiotics. Although pneumothorax and colonic injury are more common on subcostal needle insertion, these are rare complications. [6]
Treatment of hydronephrosis focuses on the removal of the obstruction and drainage of the urine that has accumulated behind the obstruction. Therefore, the specific treatment depends upon where the obstruction lies. [14] Acute obstruction of the upper urinary tract is usually treated by the insertion of a nephrostomy tube.
Percutaneous nephrostomy: A nephrostomy is created when the flow of urine is diverted directly from the kidneys to the abdominal wall. Tubes are placed within the kidney to collect the urine as it is generated, and transport it to the abdominal wall. This procedure is usually temporary; however, it may be permanent for cancer patients.
A tube is typically also placed in the urethra or through a suprapubic opening to ensure full urine drainage and to rest the bladder during recovery. [25] The tubes are generally removed and the channel is ready to use with intermittent catheters in 4–6 weeks, [25] provided that a medical professional first instructs on how to catheterize. [23]
The Boari flap technique reshapes part of the bladder wall into a tube to replace a damaged ureter segment, while appendiceal ureter interposition uses the appendix as a substitute for the ureter. For more extensive reconstruction, the ileal ureter approach repurposes a segment of the small intestine (ileum) to create a new channel for urine ...
Percutaneous nephrolithotomy (PCNL) is a minimally-invasive procedure to remove stones from the kidney by a small puncture wound (up to about 1 cm) through the skin. It is most suitable to remove stones of more than 2 cm in size and which are present near the pelvic region.
Alternatively, drainage tubes are passed over the guidewire (as in chest drains or nephrostomies). After passing a sheath or tube, the guidewire is withdrawn. [1] An introducer sheath can be used to introduce catheters or other devices to perform endoluminal (inside the hollow organ) procedures, such as angioplasty.
The gold standard of treatment for these types of stones is surgical removal. However, some patients have an infected stone and are simply too ill for an operative surgical removal. In these instances, the mainstay of IR treatment is a percutaneous nephrostomy tube. [24]