Nephrostoma

A nephrostomy is a medical procedure in which a hole is created in the kidney and a special catheter (nephrostomy catheter) is placed through the hole to allow urine to drain from the kidney to an external reservoir or collection device. This procedure may be necessary for a variety of conditions and diseases of the kidneys when normal urine flow is impaired or additional drainage of the urinary system is required.

Here are some of the reasons why a nephrostomy may need to be placed:

1. Urinary tract obstruction: If the urinary tract is blocked by tumors, stones, or other obstructions, a nephrostomy may be placed to allow normal urine outflow from the kidney.
2. Permanent access to the urethra: Placement of a nephrostomy may be necessary for long-term monitoring diagnostics, renal examinations, or to provide access to the renal urethra during diagnostic or treatment procedures.
3. Drainage of pustular abscesses: In cases of abscess formation in the kidney, a nephrostomy can be used to drain the pus and relieve pressure.
4. Preparation for surgery: Sometimes a nephrostomy may be placed as a temporary measure before kidney surgery to provide better conditions for surgery.

Nephrostomy placement and care is performed by medical personnel and requires specialized skills and supervision. This procedure may be temporary or permanent, depending on medical conditions.

ICD-10 codes

• N13.6 - Bladder obstruction (if the nephrostomy was placed due to bladder blockage).
• N28.8 - Other specified renal dysfunction (if the nephrostomy was placed for another reason that does not fall under other specific codes).
• T83.5 - Infection and inflammation following medical procedures not elsewhere classified (if the nephrostomy caused the infection or inflammation).
• Z48.0 - Nephrostomy placement and reinsertion (this code may be used to indicate a procedure for nephrostomy placement).

Indications for the procedure

A nephrostomy (or nephrostomy catheter) may be placed in the following cases:

1. Urinary tract obstruction: When the urinary tract is blocked, such as by stones, tumors, or other obstructions, a nephrostomy can be placed to allow urine to drain from the kidney and prevent its accumulation.
2. Permanent access to the urinary system: A nephrostomy can be inserted to allow permanent access to the renal urinary system for diagnostic, monitoring and treatment purposes. This can be useful in cases where it is necessary to take regular urine samples or administer medication directly into the kidney.
3. Pus abscess drainage: If an abscess (pus cavity) has formed in the kidney tissue, a nephrostomy can be used to drain the pus and provide relief to the patient.
4. Preparing for surgery: Sometimes a nephrostomy may be inserted as a temporary measure before kidney surgery. It may be used to ensure optimal conditions for surgery.
5. Symptom relief and treatment of kidney disease: In some cases where kidney function is severely impaired, a nephrostomy may be placed to relieve symptoms and improve the patient's quality of life.

The decision on the necessity is based on medical indications and should be made by the physician after a thorough examination and evaluation of the patient's condition. Nephrostomy placement and care require specialized skills and medical supervision.

Preparation

The following are general steps to prepare for the nephrostomy procedure:

1. Consultation with your doctor: The first step is a consultation with your doctor, who will determine the need for a nephrostomy and explain the process and expectations. The doctor will also perform an examination and may order additional medical tests to evaluate your kidneys and overall health.
2. Discussing the plan: Your doctor will explain to you how the nephrostomy will be performed, what materials and equipment will be used, and the risks and expected outcomes associated with the procedure.
3. Patient preparation: Before the procedure, it is important to follow your doctor's instructions regarding food and fluid intake. You may be required to undergo a colon cleansing prior to the procedure if your physician deems it necessary.
4. Consent: You will be given informed consent and explanations of the procedure. Read them carefully and ask questions if anything is unclear.
5. Medical History: Provide your doctor with your medical history, including information about existing medical conditions, drug allergies, and previous surgeries.
6. Tests and Tests: Your doctor may order laboratory tests and educational procedures to determine your general preparedness for nephrostomy.
7. Preventing infections: To prevent infections, you may need antibiotics or other preventive measures your doctor prescribes before your procedure.
8. Preparing for post-procedure care: Plan how you will care for your nephrostomy after the procedure. You may need to be trained in nephrostomy care and catheter changing.
9. Prepare psychologically: Prepare yourself psychologically for the procedure and consider discussing your concerns and expectations with the psychologist or supervisor.
10. Clarifying details: Before the procedure, check with your doctor about what medications you can or cannot take before the nephrostomy and when and where the procedure will be performed.

Preparing for a nephrostomy requires attention to detail and cooperation with your medical team. Follow your doctor's and nurse's instructions for caring for your health after the procedure.

Nephrostomy kit

This is a set of medical supplies used for nephrostomy care and urine collection. This kit is usually provided to patients who have a nephrostomy and includes the following components:

1. Urine collection bag: This is a special bag or pouch that is attached to the nephrostomy and is used to collect the urine that has been excreted. The pouch can be disposable or reusable depending on the type and patient preference.
2. Nephrostomy catheter: This catheter is a tube or cannula that connects to the nephrostomy and allows urination through it. Nephrostomy catheters come in different types and sizes, and the choice depends on the patient's needs.
3. Terminals or clips: Sometimes a nephrostomy kit includes terminals or clips that are used to regulate the flow of urine from the nephrostomy to the pouch. They allow you to temporarily stop the flow of urine if needed.
4. Sterile compresses and bandages: Sterile compresses and bandages may be included to care for the skin around the nephrostomy and to prevent infection.
5. Cleaning Solution: You may need a special solution or product to clean and care for your nephrostomy.
6. Care instructions: The kit may also contain instructions for nephrostomy care and urine collection, as well as contact information for consultation with medical personnel if needed.
7. Other components: In some cases, the kit may include additional components depending on the needs and individual circumstances of the patient.

The nephrostomy kit and its contents may vary depending on the country, medical practice and type of nephrostomy. It is important that the patient receives detailed training on nephrostomy care and kit use from medical staff.

Technique of the nephrostomies

Here is the general technique for performing a nephrostomy:

1. Patient preparation: The patient may be offered general or local anesthesia depending on the specifics of the procedure and health status. Before the procedure, the patient is explained what to expect and consent is obtained.
2. Site preparation: The surgeon will aseptically treat the site where the nephrostomy will be performed. This includes washing and treating the skin with antiseptics.
3. Performing the procedure: The surgeon makes a small incision in the skin and subcutaneous tissue and inserts a thin metal or plastic catheter tube (catheter) into the kidney cup or pelvis. The tube is fixed in place and connected to a collection container to drain urine.
4. Completion of the procedure: After completion of the nephrostomy, a follow-up radiographic examination is performed to ensure that the catheter is properly positioned and there are no complications.
5. Nephrostomy care: After the procedure, it is important to take good care of the nephrostomy. This includes changing the bandage regularly, treating the skin around the nephrostomy and watching for possible symptoms of infection or other complications.
6. Monitoring medical team: The patient is given instructions on how to monitor the nephrostomy and report any problems to the physician or medical team. Regular visits to the physician for evaluation and care of the nephrostomy may be necessary.

Nephrostomy is an important procedure that can help patients with certain genitourinary problems. The technique may vary slightly depending on your specific situation and the surgical technique used in your case. This procedure is performed by experienced surgeons, and it is important to follow all recommendations and doctor's orders to ensure safe and effective treatment.

Nephrostomy placement, replacement, and removal are procedures performed by medical professionals to create and maintain an artificial opening in the kidney (nephrostomy) through which urine can be collected or diagnostic and treatment procedures can be performed. The basic steps of each of these procedures are described below:

1. Nephrostomy placement:

   • Preparation: The patient undergoes preparation, which may include blood tests, kidney evaluation, and general health assessment.
   • Local anesthesia: The area where the nephrostomy will be placed is anesthetized locally to reduce pain during the procedure.
   • Ultrasound or X-ray guidance: An ultrasound or X-ray image is used to determine the exact location of the kidney and ureter where the nephrostomy will be placed.
   • Catheter insertion: A medical professional inserts a special catheter through the skin and into the ureter.
   • Securing the nephrostomy: After securing the catheter in place, the technician creates an opening (stoma) in the skin and attaches a bag or system to the nephrostomy to collect urine.
   • Care training: Patient is provided with training in nephrostomy care and pouch changing.

2. Nephrostomy replacement:

   • Need Assessment: A medical professional evaluates the condition of the nephrostomy and determines if it needs to be replaced.
   • Preparation: The patient undergoes preparation, as with nephrostomy placement, to prevent infections and ensure the safety of the procedure.
   • Replacement: The old nephrostomy is removed and a new one is placed in the same location or another convenient location, depending on individual circumstances.
   • Care training: The patient will receive instructions on how to care for the new nephrostomy and how to collect urine.

3. Nephrostomy removal:

   • Necessity assessment: A medical professional evaluates the kidney and decides that a nephrostomy is no longer needed.
   • Preparation: The patient may undergo preparation similar to that for nephrostomy placement to ensure the safety of the procedure.
   • Removal: A medical professional removes the nephrostomy by closing the stoma on the skin.
   • Post-procedure care: The patient is advised on skin care after nephrostomy removal and mandatory medical follow-up.

It is important to note that nephrostomy insertion, replacement and removal procedures are performed by specialists and are subject to medical supervision to prevent complications and ensure patient safety.

Nephrostomy lavage

This is an important procedure for caring for the artificial opening in the kidney through which urine is passed. Flushing helps prevent infections, collect urine samples and keep the stoma clean and working properly. It is important to perform this procedure with care and following good hygiene practices. Here's how you can flush a nephrostomy:

1. Prepare all necessary materials:
2. Soapy water or a special solution recommended by your doctor.
   • Sterile gloves.
   • Sterile syringes or special equipment for flushing a stoma.
   • Sterile compresses or cotton swabs.
   • Wipes and mousse balls.
3. Prepare yourself: Wear sterile gloves to prevent infection.
4. Prepare the solution: If your doctor has not prescribed a specific solution for flushing, use mild baby soap and warm water to prepare the solution. Dissolve a few drops of soap in clean water. It is important that the solution is mild and does not irritate the skin.
5. Flushing:
   • a. Carefully remove previous drainage (if placed) and dressing remnants.
   • b. Using a syringe or specialized equipment, slowly inject the solution into the nephrostomy. Use gentle movements and do not apply strong pressure to avoid damaging or irritating the stoma.
   • c. After injecting the solution, gently suck the solution back into the syringe or with the equipment.
   • d. Repeat the flushing procedure several times until the stoma is clean and urine no longer comes out in solution.
6. Completion of the procedure:
   • a. Carefully suck any remaining moisture out of the stoma.
   • b. Wrap the stoma with a sterile compress or cotton swab and secure it with medical tape or special bandages.
7. Remove gloves and wash hands thoroughly with soap and water.

It is important to perform nephrostomy flushing as recommended by your physician and not to attempt it yourself unless you have the proper training or experience. If you have any problems related to your nephrostomy, contact your doctor or health care professional for advice and assistance.

Consequences after the procedure

Several effects and complications can occur after a nephrostomy, including:

1. Pain and discomfort: After the procedure, the patient may experience pain and discomfort in the nephrostomy area. This is usually temporary and can be relieved with medication and other pain management techniques.
2. Infections: Occurrences of infections at the site of insertion of the nephrostomy catheter may be possible. Patients should carefully observe hygiene procedures and follow the physician's recommendations for nephrostomy care to reduce the risk of infections.
3. Changes in urination: The use of a nephrostomy may change the pattern of urination. Urine may exit through the catheter and collect in a collection device rather than through the urethra.
4. Risk of catheter dislodgement or clogging: The catheter may be inadvertently dislodged or clogged, which may require medical intervention to correct the situation.
5. Bleeding: Occasionally, there may be some bleeding from the catheter insertion site after the procedure.
6. Other complications: In some cases, other complications such as scar tissue formation, allergic reactions to catheter materials, etc. May occur.

It is important for patients who have had a nephrostomy to maintain close contact with their physician and follow his or her recommendations for nephrostomy care to minimize the risk of complications and ensure good treatment outcomes.

Complications after the procedure

Like any other medical procedure, a nephrostomy can cause various complications. Some of the possible complications include:

1. Infections: One of the most common complications is infection around the stoma or in the bladder.
2. Bleeding: Bleeding may occur during or after the procedure.
3. Blood clots: In some cases, blood clots may form in the bladder or ureter.
4. Stone formation: The urine flowing through the nephrostomy may contain substances that contribute to stone formation.
5. Deterioration of kidney function: In some cases, a nephrostomy may lead to deterioration of kidney function.
6. Reaction to stoma material: Sometimes the body can react to the material used to create the stoma, causing an allergic reaction or irritation.
7. Stoma displacement or blockage: A stoma may become displaced or clogged, requiring medical correction.
8. Pain and discomfort: Pain and discomfort may occur after the procedure.

To reduce the risk of complications, it is important to follow your physician's instructions and recommendations after a nephrostomy procedure and to regularly monitor your stoma and stoma care. If you have specific questions or concerns about complications after a nephrostomy procedure, be sure to discuss them with your doctor.

Nephrostomy failure

Also known as nephrostomy dysfunction, is a condition in which the nephrostomy (an artificial opening in the kidney cup or pelvis) no longer performs its function effectively. This can lead to a variety of problems, including difficulty draining urine from the kidney. Nephrostomy problems can be caused by a variety of factors, and it is important to see your doctor for evaluation and treatment. Here are some of the possible causes of nephrostomy failure:

1. Blockageor obstruction: One of the most common causes of nephrostomy failure is blockage or obstruction of the catheter that is inserted into the kidney cup or bladder. This can happen because of stones, blood clots, infection, or other materials that block the free flow of urine through the catheter.
2. Infections: Infections around the nephrostomy or in the urinary tract can cause inflammation and changes in tissue structure, which can lead to impaired nephrostomy function.
3. Movement or displacement of the catheter: If the nephrostomy catheter moves due to physical activity or other factors, this can cause failure because the catheter will not be in the correct position to drain urine.
4. Scar tissue development: After several nephrostomy procedures, scar tissue may develop around the catheter, which can impair catheter function.
5. Equipment problems: Defects or damage to the catheter itself or other equipment components can cause nephrostomy failure.

Treatment of nephrostomy failure depends on its cause and may include:

• Performing a catheter cleaning or changing procedure.
• Treating the infection with antibiotics.
• Correcting the position of the catheter or inserting a new catheter.
• Surgical interventions when necessary.

If you have problems with the function of your nephrostomy or suspect an incompetent nephrostomy, please consult your physician. It is important to identify and treat nephrostomy problems early to avoid complications and maintain nephrostomy function.

Care after the procedure

Nephrostomy (nephrostomy catheter) care is an important part of caring for patients needing this procedure. Here are some general guidelines for care after nephrostomy placement:

1. Hygiene measures: Wash your hands regularly before and after contact with the nephrostomy. Use mild soaps and avoid using strong antiseptics that can irritate the skin.
2. Care of the catheter insertion site: Inspect and care for the nephrostomy insertion site. Keep the area clean and dry. If you notice signs of inflammation, redness, swelling, or irritation, contact your doctor immediately.
3. Catheter Replacement and Maintenance: Follow your doctor's recommendations regarding the frequency and methods of nephrostomy catheter replacement. This may include maintenance and cleaning of the catheter.
4. Observe antiseptic measures: When performing procedures involving a nephrostomy, observe sterility and antiseptic measures. This is important to prevent infections.
5. Condition Monitoring: The patient and/or caregivers should closely monitor the condition of the nephrostomy, including the amount of urine coming out, the color of the urine, and the presence of unusual symptoms.
6. Follow your doctor's advice: Always follow your doctor's instructions and recommendations regarding nephrostomy care. This will help prevent complications and keep the catheter and surrounding tissue in good condition.
7. Cleaning the urine collection bag (if available): If a nephrostomy is used with a urine collection bag, monitor its condition, empty it regularly and change it according to your doctor's instructions.
8. Contact yourdoctor for complications: If you or a patient experiences symptoms of infection, allergic reactions, bleeding, or other unusual events, contact your doctor immediately for evaluation and treatment.

It is important to realize that nephrostomy care may vary depending on your specific circumstances and your physician's recommendations. Therefore, always consult your medical professional for individualized recommendations and instructions for nephrostomy care.

Living with a nephrostomy

Living with a nephrostomy can be a challenge, but with proper care and following doctor's recommendations, many people can live a full life. Here are some tips for living with a nephrostomy:

1. Follow yourdoctor's recommendations: It is important to follow your doctor's recommendations closely. This includes regular visits to your doctor for check-ups and follow-ups, and keeping all medical appointments.
2. Nephrostomy care: Take regular care of the nephrostomy and the surrounding skin. This includes changing bandages, cleaning and treating the skin with antiseptics, and paying attention to any changes around the nephrostomy.
3. Take charge of your health: Maintain a healthy lifestyle, including a healthy diet, physical activity, and monitoring blood pressure and blood sugar levels. It is important to minimize risk factors for conditions that can affect kidney function.
4. Nutrition: If you have been given dietary recommendations related to a nephrostomy, follow them. This may include limiting your intake of certain foods such as salt, phosphorus, and potassium.
5. Psychological support: Living with a nephrostomy can be emotionally challenging. If you need support, discuss this with your doctor and consider counseling with a psychologist or psychotherapist.
6. Social support: Tell your family and friends about your situation. Support from loved ones can be an important part of your well-being.
7. Be prepared for emergencies: Have a supply of necessary medications and equipment for nephrostomy care. Also educate your loved ones on what to do in case of emergencies.
8. Lifestyle: Despite having a nephrostomy, most people can continue to go about their normal activities and even lead an active lifestyle. However, it is important to discuss with your doctor what restrictions or recommendations may apply to physical activity.
9. Education: Learn as much as you can about your condition and your nephrostomy. Education will help you better understand your condition and improve your nephrostomy care.
10. Community Support: Consider joining a support group for people with nephrostomies. Connecting with others who are facing similar challenges can be very helpful.

Life with a nephrostomy can be challenging, but with the right care and support, you can continue to enjoy your quality of life.

Disability

The issue of disability in the case of a nephrostomy (artificial hole in the kidney) can be decided on an individual basis and depends on several factors, including the reasons that led to the need for the nephrostomy, the extent to which it affects the patient's life, and the limitations it places on their ability to perform normal daily tasks and work.

When a disability decision is made, the following aspects are considered:

1. Medical Evaluation: Evaluation of the patient's medical condition and the impact of the nephrostomy on the patient's ability to maintain self-care and normal activities of daily living is an important part of the process. Physicians perform a medical evaluation and also consider other medical conditions that may affect the patient's overall condition.
2. Functional limitations: Assesses how the nephrostomy limits the patient's ability to perform various activities and tasks such as personal hygiene, mobility, self-care, etc.
3. Medical Records: Medical records, including examinations, tests and specialist reports, may be required for disability consideration.
4. Social and Psychological Factors: Assesses how nephrostomy affects the patient's psychological well-being and ability to maintain social and family ties.

The decision to grant disability is usually made by a medical board or the agency responsible for disability evaluation in your area. If you believe that your nephrostomy significantly limits your ability to perform self-care and normal activities of daily living, you should contact a medical professional or social worker to find out if you may be eligible for disability status and related benefits.