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1. Patient Positioning
To provide flank access, the patient is placed prone with support rolls.
Nephrostomy and Ureteral Stenting
Nephrostomy and Ureteral Stenting
procedure steps
2. Surface Marking
To prevent visceral harm, a "quadrangle of safety" is indicated for needle entrance.
3. Imaging Guidance
A posterior calyx for puncture, usually a lower or middle pole calyx, is located using ultrasound or fluoroscopy.
4. Local Anesthesia
The puncture site is infused with local anesthetic.
5. Percutaneous Puncture
Using imaging guidance, a needle is inserted into the chosen calyx until urine is aspirated.
6. Guidewire Placement
A guidewire is put into the upper ureter or renal pelvis using a needle.
7. Tract Dilation
To make room for the nephrostomy tube, the access tract is gradually dilated using dilators.
8. Nephrostomy Tube Insertion
The catheter is placed into the renal pelvis above the guidewire and fastened externally with adhesive dressings and sutures.
9. Confirmation
To ensure that the drainage is attached and the catheter is placed correctly, contrast dye may be injected.
10. Post-procedure Care
After the surgery, the area is checked for infection or bleeding. Hematuria and pain are normal, however they usually go away fast.
11. Access
A guidewire is sent via the renal pelvis, down the ureter, and into the bladder via the nephrostomy tract..
12. Dilation
The ureteral opening and tract are carefully dilated if necessary.
13. Stent Placement
To bridge the obstruction, a double-J ureteral stent with one end in the renal pelvis and the other in the bladder is advanced over the guidewire.
14. Position Verification
Fluoroscopy verifies that the stent is positioned correctly.
15. Instrument Removal
The stent is left in place after the guidewire and catheters are taken out.
16. Follow-up
Until the obstruction is removed or additional treatments are carried out, the stent permits urine to drain.
disease treated
Renal Tumors
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Lung Tumors
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Ureteric Obstruction From Tumors
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suitable for
Urinary Tract Obstruction
Patients with kidney stones, ureteral strictures, tumors, or external compression are considered to have urinary tract obstruction.
Infection and Emergency Drainage
Individuals who require immediate drainage to avoid sepsis due to pyonephrosis or obstructive urinary tract infections.
Preservation of Renal Function
Patients who have urinary obstruction-related acute renal failure require treatment to restore kidney function and urine discharge.
Trauma and Iatrogenic Injury
Urine diversion is required for the repair of ureteral lesions caused by trauma or surgery.
Therapeutic Intervention Access
Patients who require percutaneous access for operations such as biopsies, ureteral dilatation, or stone removal.
Failure or Impossibility of Retrograde Stenting
Situations in which cystoscopy-based traditional ureteral stenting is either difficult or unsuccessful.
Palliative Care for Cancer
Individuals with malignant ureteral blockage who require better quality of life and symptom reduction.
benefits
Quick Relief
Nephrostomy and ureteral stenting offer quick and efficient relief from kidney blockage and infection symptoms. These treatments lessen the excruciating pressure accumulation inside the kidney by allowing urine to drain normally, relieving agony and averting additional harm.
Maintaining Renal Function
By guaranteeing urine flow and decompressing the urinary system, these therapies aid in maintaining kidney health. This protects overall renal function by lowering the risk of kidney injury or failure that may arise if a blockage is not addressed.
Technique with Minimal Invasiveness
In order to limit tissue damage and shorten recovery times, both procedures are carried out with tiny incisions under imaging guidance. Compared to open surgery, this less invasive method causes fewer problems, less discomfort, and shorter hospital stays.
Controlling Infections
Because it enables efficient drainage of infected urine, nephrostomy is especially helpful in cases with infected urinary blockage. When paired with the right medications, this drainage aids in the management and resolution of diseases like pyonephrosis, preventing systemic spread like sepsis.
Availability of Additional Therapy
Nephrostomy provides access to the kidney for further procedures such as tumor biopsy or stone extraction. Ureteral stents enable continuous management without the need for external drainage bags by maintaining an internal urinary route to avoid blockages.
Improved Quality of Life and Comfort for Patients
Because ureteral stenting eliminates the need for external tubes, patients find it more convenient and comfortable. Both operations improve everyday functioning and mobility by relieving uncomfortable symptoms, particularly when used as palliative measures for blockages caused by cancer.
post-treatment recovery
Initial Monitoring and Hospital Stay
Patients usually stay in the hospital for one night for monitoring following nephrostomy or ureteral stenting procedures.
This enables medical professionals to make sure the patient is stable before release and to check for problems like bleeding or infection.
Management of Pain and Discomfort
The insertion site may cause some little pain or discomfort for patients, but this normally goes away in a few days.
NSAIDs and prescription analgesics are good ways to control pain, and discomfort usually goes away over time.
Symptoms of the Urine
Patients may have modest pelvic pain, urgency, or frequent urination after ureteral stent implantation.
Usually transient, these symptoms go away when the body becomes used to the stent.
Limitations on Activity and Recuperation Time
To ensure that the puncture site heals properly, patients are recommended to refrain from heavy lifting and physically demanding activities for at least two weeks following the surgery.
Most people can return to their regular daily activities in one to two weeks, while individuals who have physically demanding occupations may need more time to heal.
Tube and Stent Maintenance
To avoid obstruction and infection, nephrostomy tubes need to be properly cared for and maintained.
Instructions on how to handle the external catheter are given to patients. Ureteral stents need to be removed or replaced on a scheduled basis and are often left in place for up to six months.
Monitoring and Extended Care
To monitor kidney function, check for problems, and schedule the prompt removal or replacement of stents or nephrostomy tubes, routine follow-up sessions are crucial.
