Imaging percutaneous nephrostomy

Percutaneous Nephrostomy (PCN)

Objectives

In cases of upper urinary tract obstruction:

•   Drainage of supravesical upper urinary tract

•   Pyonephrosis drainage and assessment of recoverable function

•   Access to upper urinary tract for stone removal, stricture dilatation, stent placement.

Patient Preparation

• Blood prothrombin time

•   Antibiotic cover if required

•   Fasting for 6 hours

•   Children to be well hydrated

•   Surgical cleaning and draping of the back.

Position

Prone with sandbang under abdomen.

Anesthesia

•   IV sedation with diazepam

•   Local infiltration analgesia with 1% xylocaine, 10 ml

•   General anesthesia may be required for infants and uncooperative children.

Instruments

•   18 G, 20 cm long needle with stilet

•   0.035" or 0.038" diameter, 100 cm long J-shaped guidewire

•   Sterile surgical blades

•   Graded teflon dilators 7F-10F

•   Drainage catheter 8F-10F, pigtail with multiple holes/Malecot catheter

•   Suture and needle for fixation of catheter

•   Adhesive tape

•   Connector

•   3-way stopcock

•   Urine collection bag.

Procedure

   1.  Sonographic or fluoroscopic guidance depending on operators’ convenience and choice.

   2.  Calyx to be punctured, chosen depending on indication for PCN.

   3.  Puncture as laterally as possible, through renal paren­chyma.

   4.  Puncture chosen calyx under guidance with 18 G needle.

   5.  Remove stilette of needle; pass guidewire. Check position of guidewire within pelvicaliceal system.

   6.  Stab incision along needle tract.

   7.  Dilate tract to one size above catheter size.

   8.  Place catheter in pelvicaliceal system over guidewire.

   9.  Remove guidewire.

10.  Connect catheter to urine collection bag.

11.  Suture catheter and skin wound.

12.  Secure catheter to skin with adhesive tape.

Complications

•   Perinephric hematoma

•   Hematuria.

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