Urology And Urosurgery
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A nephrostomy is a surgical procedure by which a tube, stent, or catheter is inserted through the skin and into the kidney.
The ureter is the fibromuscular tube that carries urine from the kidney to the bladder. When this tube is blocked, urine backs up into the kidney. Serious, irreversible kidney damage can occur because of this backflow of urine. Infection is also a common consequence in this stagnant urine.
Nephrostomy is performed in several different circumstances:
- The ureter is blocked by a kidney stone.
- The ureter is blocked by a tumor.
- There is a hole in the ureter or bladder and urine is leaking into the body.
- As a diagnostic procedure to assess kidney anatomy.
- As a diagnostic procedure to assess kidney function.
Before the procedure
Your child may need to have a blood test to check everything is fine beforehand. The doctors will need to see you to explain the procedure in more detail, discuss any worries you may have and ask you to sign a consent form. If your child has any medical problems, such as allergies, please tell the doctors. An anaesthetist will also visit you to explain your childís anaesthetic in more detail.
Nephrostomy is done by an interventional radiologist or urologist with special training in the procedure. It can be done either as an inpatient or an outpatient procedure, depending on why it is needed. For most cancer patients, nephrostomy is an inpatient procedure that is covered by insurance.
First, the patient is given an anesthetic to numb the area where the catheter will be inserted. The doctor then inserts a needle into the kidney. There are several imaging technologies such as ultrasound and computed tomography that are used to help the doctor guide the needle into the correct place.
Next, a fine guide wire follows the needle. The catheter, which is about the same diameter as IV tubing, follows the guide wire to its proper location. The catheter is then connected to a bag outside the body that collects the urine. The catheter and bag are secured so that the catheter will not pull out. The procedure usually takes one to two hours.
After the procedure
Your child will return to the ward after he or she has recovered from the anaesthetic. After an anaesthetic, some children feel sick and may vomit. They may have a headache, sore throat or feel dizzy. These side effects donít usually last long, are not severe, and are easily treated with medication.
Your child will be visited regularly by the medical team to check on his or her progress. They will check the urine for infection, and give antibiotics intravenously (into a vein) if necessary. Your child may be able to go home with the nephrostomy tubes in place, and ward staff will inform you if this is the case. Your child will then come back to the hospital for scans to see whether their kidney function is getting better.
In a successful nephrostomy, the catheter is inserted, and urine drains into the collection bag. How long the catheter stays in place depends on the reason for its insertion. In people with pelvic cancer or bladder cancer where the ureter is blocked by a tumor, the catheter will stay in place until the tumor is surgically removed. If the cancer is inoperable, the catheter may have to stay in place for the rest of the patient's life.
A nephrostomy is an established and generally safe procedure. As with all operations, there is always a risk of allergic reaction to anesthesia, bleeding, and infection.
Bruising at the catheter insertion site occurs in about half of people who have a nephrostomy. This is a minor complication. Major complications include the following:
- Injury to surrounding organs, including bowel perforation, splenic injury, and liver injury
- Infection, leading to septicemia
- Significant loss of functioning kidney tissue (< 1%)
- Delayed bleeding, or hemorrhage (< 0.5%)
- Blocking of a kidney artery (< 0.5%)
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