Nephrostomy belongs to urostomies, i.e. stomas performed on the urinary tract. A nephrostomy is a transcutaneous catheterization of the kidney. The very word "stoma" means the deliberate creation of a connection between an internal organ and the skin. If such a connection is formed spontaneously as a result of an illness or other pathology, it is called a fistula. What is a nephrostomy?
Percutaneous nephrostomyis a procedure in which a nephrostomy catheter is inserted through the body integuments. Nephrostomy is performed under local infiltration anesthesia under the control of an ultrasound or X-ray machine. The patient is placed on the stomach or the opposite side, after which the doctor, after a preliminary ultrasound assessment and anesthesia, punctures the skin and inserts a special "wire". The puncture is then gradually expanded and a nephrostomy drain is inserted. After insertion into the kidney, this drain curls and takes the characteristic shape of a "pig's tail". Thanks to a special, perforated structure, it facilitates the drainage of urine from the calicotropic system. The nephrostomy drain goes outside and drains the urine into a special nephrostomy bag that the patient can hide under their clothes. Sometimes a nephrostomy is performed during an operation under general anesthesia.
When is a nephrostomy required?
A nephrostomy is necessary if it is not possible for the kidney to drain urine for any reason. If this procedure is not performed, residual urine will gradually lead to the formation of hydronephrosis and ultimately to renal failure. The main indications for a nephrostomy are:
- a tumor that causes compression of the ureters or infiltrates the ureter - these tumors include not only cancers of the urinary tract, but also, for example, ovarian, cervical, prostate or rectal cancer. These tumors gradually increase in size, and even if initially unrelated to the urinary tract, they may eventually completely block the outflow of urine from the kidney and cause hydronephrosis;
- calculus located in the renal pelvis or ureter - urolithiasis is a relatively common cause of acute urinary tract obstruction. If the stone is large in size, it will not pass by itself through the renal pelvis or ureters, and urgent nephrostomy is sometimes required toacute post-renal renal failure has not developed;
- post-inflammatory changes in the ureter - both non-specific and specific inflammations, such as tuberculosis, for example, can cause inflammatory fibrosis and thickening of the ureters, which will result in impaired drainage of urine from the kidney;
- Iatrogenic or traumatic ureteral injury - In abdominal or pelvic surgery, ureteral injury occurs. Their continuity can also be interrupted as a result of various injuries. In both cases, a nephrostomy is necessary to create an alternative route for urine to drain from the kidney;
- narrowing of the ureters as a result of radiotherapy - irradiation is used in the treatment of some neoplasms of the pelvic organs. Although this method has many advantages, it can also damage and fibrosis blood vessels and other tissues surrounding the ureters, which may result in the ureters becoming narrowed or even completely overgrown, which will also require a nephrostomy.
- prophylactic nephrostomy after removal of a fragment of the renal pelvis together with the tumor;
- pharmacological nephrostomy to provide direct access of pharmacological agents (for example, antibiotics) to the calyx-pelvic system;
- diagnostic nephrostomy - diagnosis of unclear hydronephrosis, cyst or abscess of unclear origin;
Nephrostomy - how long is it needed?
How long a nephrostomy must remain in the patient's body is completely individual and largely depends on the reason for its insertion. If a nephrostomy has been performed in a patient with cancer and cannot be completely resected, it may remain permanent. However, when a nephrostomy is an emergency procedure and its cause can be removed, it remains with the patient only for a certain time, for example until the narrowed section of the ureter is dilated by special stents.
Complications of nephrostomy
Possible complications of nephrostomy are mainly those that accompany other procedures, such as bleeding or infection. It is important to follow good hygiene practices when changing nephrostomy bags to minimize the risk of infection. Proper watering is important, a minimum of 2 liters per day. It may also be beneficial to consume cranberry, which is a widely recognized non-pharmacological method of preventing urinary tract infections. The patient should regularly observe and control the appearance of urine output and the area where the nephrostomy exits the body, and urgently consult a doctor ifanything that worries him in these respects.