50395 Introduction of guide into renal pelvis and/or ureter with dilation to establish nephrostomy tract, percutaneous

Name of the Procedure:

Introduction of guide into renal pelvis and/or ureter with dilation to establish nephrostomy tract, percutaneous

• Common Name: Percutaneous Nephrostomy (PCN)
• Medical Term: Percutaneous Nephrostomy Tract Dilation

Summary

A percutaneous nephrostomy is a procedure where a guide wire is introduced into the kidney's renal pelvis or ureter, and the tract is dilated to allow a nephrostomy tube to be placed. This tube helps drain urine directly from the kidney into a collecting bag outside the body.

Purpose

Medical Condition or Problem:

• Blocked or obstructed urinary pathway due to stones, tumors, or strictures.
• Urinary tract infections that prevent normal drainage.

Goals and Expected Outcomes:

• Relieve urinary blockage.
• Restore proper urine flow from the kidney.
• Prevent kidney damage caused by obstruction.
• Reduce infection risk.

Indications

Symptoms or Conditions:

• Severe hydronephrosis (swelling of a kidney due to a blocked ureter).
• Kidney stones causing blockage.
• Tumors obstructing the urinary tract.
• Severe urinary tract infections.

Patient Criteria:

• Patients with acute or chronic ureteral obstruction.
• Individuals not suitable for immediate surgical intervention.

Preparation

Pre-Procedure Instructions:

• Fasting for 6-8 hours before the procedure.
• Temporarily adjusting certain medications as advised by the physician.

Diagnostic Tests:

• Imaging studies like ultrasound, CT scan, or X-ray to locate blockage.
• Blood tests to assess kidney function and coagulation profile.

Procedure Description

1. Initial Imaging: Imaging is conducted to guide the insertion.
2. Insertion of Guide Wire: A small puncture is made in the skin, and a guide wire is inserted into the renal pelvis or ureter.
3. Dilation: The tract is gradually widened using special dilators.
4. Nephrostomy Tube Placement: A tube is placed over the guide wire into the dilated tract, leading to external drainage.

Tools and Equipment:

• Imaging equipment (ultrasound, fluoroscopy).
• Guide wires, dilators, and nephrostomy tubes.

Anesthesia or Sedation:

• Typically performed under local anesthesia, sometimes with sedation if required.

Duration

The procedure typically takes about 1 to 2 hours, depending on complexity.

Setting

Usually performed in a hospital's radiology or imaging department.

Personnel

• Interventional Radiologists
• Radiology Technologists
• Nurses
• Anesthesiologists (if sedation is used)

Risks and Complications

Common Risks:

• Bleeding at the puncture site.
• Infection.

Rare Risks:

• Injury to adjacent organs.
• Dislodgement of nephrostomy tube.
• Allergic reaction to contrast materials used.

Management:

• Continuous monitoring and antibiotic administration for infection control.
• Immediate medical attention for dislodged tubes or other complications.

Benefits

• Immediate relief from urinary obstruction.
• Prevention of further kidney damage.
• Decrease in infection risk.

Expected Timeline:

• Benefits are typically realized immediately following the procedure.

Recovery

Post-Procedure Care:

• Monitoring of kidney function and urine output.
• Care instructions for the nephrostomy tube, including how to manage the external drainage bag.

Recovery Time:

• Most individuals can return to normal activities within a few days, with some physical restrictions.

Follow-Up:

• Regular follow-up appointments to check the tube placement and kidney health.

Alternatives

Other Treatment Options:

• Ureteral stent placement.
• Surgical removal of the obstruction.
• Observation and medical management for non-severe cases.

Pros and Cons:

• PCN provides immediate relief, unlike observation or medical management.
• Surgical removal is more invasive with a longer recovery time compared to PCN.

Patient Experience

During the Procedure:

• Mild discomfort at puncture site.
• Possible sensation of pressure during dilation.

After the Procedure:

• Mild pain or discomfort managed with prescribed pain relief.
• Instructions provided for care of the nephrostomy tube and drainage bag.

Pain Management and Comfort:

• Pain relief through prescribed medications.
• Proper tube care to prevent infection and further discomfort.