Name of the Procedure:

Convert Nephrostomy Catheter to Nephroureteral Catheter, Percutaneous, including Diagnostic Nephrostogram and/or Ureterogram, Imaging Guidance (e.g., Ultrasound and/or Fluoroscopy), and All Associated Radiological Supervision and Interpretation

Summary

This procedure involves converting an existing nephrostomy catheter, which drains urine directly from the kidney, to a nephroureteral catheter, which extends into the ureter to facilitate drainage. Imaging techniques such as ultrasound or fluoroscopy are used to guide the process.

Purpose

This procedure is performed to improve urine drainage from the kidney to the bladder, especially in cases where there is a blockage or narrowing in the ureter. It aims to reduce kidney infections, alleviate pain, and prevent further kidney damage.

Indications

• Kidney stones causing ureteral obstruction
• Ureteral strictures or narrowing
• Post-surgical complications leading to ureter blockages
• Persistent urinary tract infections
• Hydronephrosis due to urinary obstruction

Preparation

• Fasting for a certain period prior to the procedure, typically 6-8 hours
• Adjustment of medications, particularly blood thinners
• Conducting blood tests to check kidney function and coagulation profile
• Allergies to contrast dye or iodine should be reported

Procedure Description

1. The patient is positioned, usually on their stomach, and the procedure area is sterilized.
2. Imaging guidance, such as ultrasound or fluoroscopy, is used to visualize the current catheter and surrounding anatomy.
3. A diagnostic nephrostogram or ureterogram may be performed to assess the urinary system.
4. The nephrostomy catheter is carefully exchanged for a nephroureteral catheter, extending it from the kidney through the ureter.
5. The correct placement is confirmed using imaging techniques.
6. The catheter is secured, and a dressing is applied to the site.

The procedure is typically performed under local anesthesia, sometimes with sedation for additional comfort.

Duration

The procedure usually takes between 1 to 2 hours.

Setting

This procedure is carried out in a hospital's interventional radiology suite or a specialized outpatient surgical center.

Personnel

• Interventional Radiologist or Urologist
• Radiologic Technologist
• Registered Nurse
• Anesthesiologist, if sedation or general anesthesia is required

Risks and Complications

• Infection at the catheter insertion site
• Bleeding or hematoma formation
• Injury to the kidney or ureter
• Allergic reaction to contrast dye
• Displacement of the catheter
• Pain or discomfort at the insertion site

Benefits

• Improved drainage of urine from the kidney to the bladder
• Relief from symptoms such as pain and infection
• Prevention of kidney damage
• Enhanced quality of life

Recovery

• Patients may experience mild discomfort at the insertion site, managed with over-the-counter pain medications.
• Instructions on how to care for the catheter, including keeping the area clean and dry.
• Avoid heavy lifting or strenuous activities for a few days.
• Follow-up appointments for catheter maintenance and monitoring.

Alternatives

• Continued use of the nephrostomy catheter
• Surgical options to remove the obstruction
• Use of ureteral stents
• Observation in cases of mild obstructions

Each alternative has its own pros and cons related to effectiveness, recovery time, and potential risks.

Patient Experience

During the procedure, the patient may feel slight pressure but minimal pain due to the local anesthesia. Post-procedure, some soreness or discomfort around the insertion site is common. Pain management and comfort measures will be provided to ensure a smooth recovery.