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Percutaneous Nephrostomy with Extensions of the Technique: Step by Step¹

¹ From the Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1088. Presented as an education exhibit at the 2000 RSNA scientific assembly. Received September 7, 2001; revision requested January 14, 2002, and received January 30; accepted January 30. Address correspondence to R.B.D. (e-mail: rdyer@wfubmc.edu).

Minimally invasive therapy in the urinary tract begins with renal access by means of percutaneous nephrostomy. Indications for percutaneous nephrostomy include urinary diversion, treatment of nephrolithiasis and complex urinary tract infections, ureteral intervention, and nephroscopy and ureteroscopy. Bleeding complications can be minimized by entering the kidney in a relatively avascular zone created by branching of the renal artery. The specific site of renal entry is dictated by the indication for access with consideration of the anatomic constraints. Successful percutaneous nephrostomy requires visualization of the collecting system for selection of an appropriate entry site. The definitive entry site is then selected; ideally, the entry site should be subcostal and lateral to the paraspinous musculature. Small-bore nephrostomy tracks can be created over a guide wire coiled in the renal pelvis. A large-diameter track may be necessary for percutaneous stone therapy, nephroscopy, or antegrade ureteroscopy. The most common extension of percutaneous nephrostomy is placement of a ureteral stent for treatment of obstruction. Transient hematuria occurs in virtually every patient after percutaneous nephrostomy, but severe bleeding that requires transfusion or intervention is uncommon. In patients with an obstructed urinary tract complicated by infection, extensive manipulations pose a risk of septic complications.

© RSNA, 2002

Index Terms: Genitourinary system, interventional procedures, 81.1263 • Kidney, interventional procedures, 81.1263 • Ureter, interventional procedures, 82.1263

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