50040 Nephrostomy, nephrotomy with drainage

Name of the Procedure:

Nephrostomy, Nephrotomy with Drainage

Summary

Nephrostomy, nephrotomy with drainage is a medical procedure used to relieve obstruction or blockage in the kidneys. It involves making an incision in the kidney to insert a drainage tube, allowing urine to bypass any obstructions.

Purpose

The procedure is primarily used to address conditions that obstruct the normal flow of urine from the kidney to the bladder, such as kidney stones, strictures, or tumors. The main goal is to ensure effective drainage of urine to prevent kidney damage and alleviate symptoms like pain and infection.

Indications

• Severe obstruction due to kidney stones or tumors.
• Hydronephrosis (swelling of the kidney due to urine retention).
• Infections that are not responding to antibiotics.
• Trauma to the urinary system.

Preparation

• Patients may be asked to fast for several hours before the procedure.
• Certain medications may need to be adjusted or discontinued.
• Blood tests and imaging studies (e.g., ultrasound, CT scan) may be required to assess kidney function and anatomy.

Procedure Description

1. The patient is typically given local or general anesthesia.
2. Using imaging guidance, a small incision is made in the side or back to access the kidney.
3. A needle is inserted into the kidney to create a pathway for a guidewire.
4. A drainage tube (nephrostomy tube) is then threaded over the guidewire and positioned in the kidney.
5. The tube is secured in place, and a drainage bag is attached to collect urine.
6. The incision site is dressed and bandaged.

Duration

The procedure typically takes about 1-2 hours.

Setting

Nephrostomy, nephrotomy with drainage is usually performed in a hospital or surgical center under sterile conditions.

Personnel

• Urologist or interventional radiologist
• Surgical nurses
• Anesthesiologist or anesthetist (if general anesthesia is used)
• Radiologic technologist (for imaging guidance)

Risks and Complications

• Infection at the incision site or within the kidney.
• Bleeding or hematoma.
• Injury to surrounding organs.
• Dislodgement or blockage of the drainage tube.
• Rarely, severe complications like sepsis.

Benefits

• Relief from pain and discomfort due to kidney obstruction.
• Prevention of further kidney damage.
• Improved kidney function and urine flow.
• Reduced risk of infections.

Recovery

• Patients may need to stay in the hospital for observation.
• Pain management will be provided as needed.
• Instructions on caring for the nephrostomy tube and changing the drainage bag.
• Usually, patients can resume normal activities within a few days, but heavy lifting should be avoided.
• Follow-up appointments to monitor healing and tube function.

Alternatives

• Ureteral stent placement.
• Percutaneous nephrolithotomy (for large kidney stones).
• Ureteroscopy (for stone removal without incision).
• Pros and cons depend on the underlying condition and patient-specific factors.

Patient Experience

During the procedure, if local anesthesia is used, the patient may feel some pressure but no pain. Afterward, there may be some discomfort at the incision site, which can be managed with pain medications. The presence of the external drainage bag requires some adjustment, but it is usually temporary. Comfort measures and support will be provided to ensure the patient's well-being.