Nephrostomy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

A nephrostomy is an artificial opening created between the kidney and the skin which allows for the drainage of urine directly from the upper part of the urinary system (renal pelvis).

Indications

A nephrostomy is performed whenever a blockage keeps urine from passing from the kidneys, through the ureter and into the urinary bladder. Without another way for urine to drain, pressure would rise within the urinary system and the kidneys would be damaged.

The most common cause of blockage necessitating a nephrostomy is cancer, especially ovarian cancer and colon cancer. Nephrostomies may also be required to treat pyonephrosis and kidney stones.

Procedure

Nephrostomies are created by surgeons or interventional radiologists and typically consist of a catheter which pierces the skin and rests in the urinary tract.

Urine is collected in an external bag which can be emptied as often as necessary.

Complications

• Perforation of the collecting system (< 30%)
• Pleural effusion, hydrothorax, and pneumothorax (< 13%)
• Acute bleeding (< 5%)
• Failed access (< 5%)
• Periorgan injury, including bowel perforation, splenic injury, and liver injury (< 1%)
• Intraperitoneal injury (< 1%)
• Infection leading to septicemia (< 1%)
• Significant loss of functioning renal tissue (< 1%)
• Delayed hemorrhage (< 0.5%)
• Emergency arterial embolization of the kidney (< 0.5%)
• Nephrectomy (< 0.2%)
• Mortality (< 0.05%)