Nephrostomy

A nephrostomy is a surgically created opening or catheter that connects the kidney to the outside of the body through the abdominal wall. It is done to allow urine to drain from the kidney when the normal route for urine output through the bladder and urethra is inaccessible or non-functional.

Nephrostomy may be required in the following cases:

1. Bladder or urethral obstruction: If the bladder or urethra is blocked or damaged, nephrostomy may be used to allow urine to drain from the kidneys.
2. After surgical procedures: Nephrostomy may be used temporarily after certain kidney surgical procedures to allow urine to drain and prevent urine from accumulating in the kidney.
3. Kidney disease treatment: In some cases, nephrostomy may be used as part of treatment for kidney disease or kidney cancer.
4. Kidney pressure control: In some situations, nephrostomy may be used to control kidney pressure and monitor kidney function.

Nephrostomy may require specific care and regular support from medical staff. Patients should maintain hygiene, monitor the condition of the catheter or orifice and consult with their doctor regularly. This is important to prevent infections and other complications.

Indications for the procedure

Indications for nephrostomy may include the following conditions:

1. Urinary tract obstruction: Nephrostomy may be performed when the urinary tract (e.g. Ureters) is blocked, narrowed or inaccessible to normal urination from the kidneys. This may be caused by stones, tumors, strictures, or other obstructions.
2. Kidney Infections: If a patient has chronic or recurrent kidney infections despite antibiotic treatment, nephrostomy may be considered as a way to facilitate urine drainage and control infection.
3. Post-traumatic conditions: After kidney injury or kidney surgery, a temporary nephrostomy may be required to allow urine drainage and protect the kidney.
4. Need for long-term monitoring: In some cases where long-term monitoring of kidney health is required, nephrostomy may be used to collect urine samples or administer medications.
5. Oncologic conditions: In cases where a patient has a malignant tumor of the kidney or nearby organs, nephrostomy may be used as a way to facilitate urine drainage after surgery or as part of treatment.
6. Renal insufficiency: In some patients with chronic renalinsufficiency, nephrostomy may be used to facilitate urination and maintain renal function.

Technique of the nephrostomy

Here is the general technique for performing a nephrostomy:

1. Patient Preparation: Before a nephrostomy is performed, the patient undergoes preliminary examinations, including a general physical examination, blood and urine tests, and a diagnostic imaging procedure (e.g., ultrasound or CT scan) to evaluate the kidneys and urinary tract.
2. Anesthesia: The procedure is usually performed under local anesthesia to anesthetize the area where the stoma will be created.
3. Sterility: The surgeon and medical staff maintain sterile conditions to prevent infection. The surgeon wears sterile clothing and uses sterile instruments.
4. Marking the stoma site: The surgeon determines the location for the stoma on the patient's skin. This is usually on the side or back of the abdomen, near the kidney.
5. Creating astoma: The surgeon makes a small incision in the skin at the marking site and then creates an opening in the renal pelvis, connecting it to the skin. He or she then creates a stoma to which a special urine collection bag is attached. The stoma is secured to the skin with sutures and/or tissue glue.
6. Completion of surgery: After creating the stoma, the surgeon closes the wound in the skin, attaches a urine collection bag, and applies a sterile dressing.
7. Post-operative care: After surgery, the patient is explained how to properly care for the stoma, including changing the urine collection bag and caring for the skin around the stoma.
8. Follow-up visits: The patient may be scheduled for follow-up visits with the doctor to assess healing and general condition and to keep the stoma in good working order.

Percutaneous puncture nephrostomy

It is a medical procedure that is used to provide temporary or permanent diversion of urine from the kidneys when it is impossible or dangerous to use the normal route of urine excretion through the urinary system.

The percutaneous puncture nephrostomy procedure includes the following steps:

1. Patient Preparation: The patient is usually medically evaluated, investigated, and discussed as to why a nephrostomy is needed. This may include urinary tract infections, urinary tract obstruction, trauma, or other medical conditions.
2. Local anesthesia: The area around the kidney is anesthetized locally before the procedure.
3. Puncture: The doctor uses a needle and a flexible catheterization tube to puncture the skin and soft tissue and access the kidney. This allows urine to be drained from the kidney into an external reservoir or urine collector that is attached to the patient's body.
4. Fixation of the nephrostomy: The urine collector is fixed to the skin to prevent it from moving or falling out.
5. Care and Maintenance: Once the nephrostomy is in place, the patient needs to keep a close eye on it, change bandages regularly and ensure proper hygiene to prevent infections and other complications.

Percutaneous puncture nephrostomy can be a temporary or permanent measure, depending on the patient's condition and the reason for which it is performed. This procedure allows for urine diversion and preserves kidney function when necessary.

Open nephrostomy

This is a surgical procedure in which an artificial opening is created in the kidney to drain urine from it directly to the surface of the body. This procedure is performed when it is impossible or undesirable to use the normal urinary route through the urinary tract due to obstruction, infection, trauma, or other medical conditions.

The open nephrostomy procedure involves the following steps:

1. Patient preparation: The patient is medically evaluated and the reasons why a nephrostomy is needed are discussed.
2. Anesthesia: Before surgery, the patient is usually given anesthesia or general anesthesia to make the procedure more comfortable and painless.
3. Surgical Access: The surgeon makes a small incision in the skin and tissue on the side of the abdomen, near the kidney that needs to drain urine.
4. Creation of a nephrostomy: The surgeon makes an incision in the kidney capsule and creates a hole through which urine will exit. A special tube is then attached to this hole, which will be used to drain the urine outside.
5. Fixation of the nephrostomy: The tube coming out of the kidney is fixed to the skin and secured with special ties or bandages.
6. Completion of the procedure: The surgeon closes the incision and sutures.

After an open nephrostomy, the patient may require special care and monitoring of the nephrostomy to prevent complications and infections. Open nephrostomy may be a temporary or permanent measure, depending on medical necessity.

Complications after the procedure

Various complications can occur after a nephrostomy procedure. It is important to keep in mind that complications can vary depending on the patient's specific situation and the technique used to create the nephrostomy. Here are some of the possible complications:

1. Infection: One of the most serious complications is infection. This can be an infection of the urinary tract, kidney, or perianal tissues. Symptoms of infection may include fever, pain in the kidney area, pain when urinating, and discoloration of the urine. The infection requires immediate treatment with antibiotics.
2. Nephrostomy blockage or clogging: The catheter or tube used in a nephrostomy may be clogged with stones, urine clots or other substances. This can lead to impaired urine outflow from the kidney and increased pressure in the kidney.
3. Skin irritation: Prolonged use of a nephrostomy may cause irritation and rash around the opening in the abdominal wall.
4. Nephrostomy dislodgement or detachment: The catheter or tube may accidentally dislodge or detach, which can cause problems with urine outflow.
5. Bleeding: In rare cases, the nephrostomy procedure may result in bleeding.
6. Renal dysfunction: Uncontrolled renal pressure due to nephrostomy may lead to deterioration of renal function.
7. Pain: Patients may experience discomfort or pain in the nephrostomy area.

Nephrostomy patients should consult their physician regularly and follow all recommendations for nephrostomy care and prevention of complications. Monitor any changes in condition and report them to the medical staff in a timely manner.

Care after the procedure

Care after a nephrostomy procedure plays an important role in preventing complications and ensuring patient comfort. Here are some basic guidelines for care:

1. Be hygienic: Wash your hands regularly before handling or touching the nephrostomy. This will help prevent infections.
2. Care of the catheter or tube: If a nephrostomy catheter or tube is used, make sure it is securely attached and not deteriorated. Check the condition of the catheter regularly and make sure it is clean.
3. Changing the urine collection bag: If urine is collected in a special bag, change it as recommended by your doctor. This may need to be done every day or every few days, depending on the type of bag and individual needs.
4. Keep the area around the nephrostomy clean: Clean and dry the skin around the nephrostomy to prevent irritation and infection. Use mild soap and water, and then gently dry the skin.
5. Bladder emptying: Depending on your condition, you may need to empty your bladder through the nephrostomy at certain intervals. This may require special instructions and training from your doctor or nurse.
6. Monitor the nephrostomy site: Regularly examine the site where the nephrostomy exits for signs of inflammation, redness, swelling, pain, or other changes. If anything looks unusual, report it to the medical staff.
7. Follow your doctor's advice: Follow all recommendations and prescriptions given by your doctor or health care team.
8. See a specialist for complications: If you have any problems such as infection, blockage, or other complications, see a doctor immediately.