 Percutaneous Nephrostomy
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Percutaneous nephrostomy is a therapeutic procedure in which a catheter is placed through the skin into the renal collecting system (fluid containing inside of the kidney) with the assistance of image guidance.
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Percutaneous nephrostomy placement performed in the Radiology Department at Children's Hospital Boston is performed with the use of image guidance (ultrasound or x-ray fluoroscopy). The procedure is performed by interventional radiologists who are physicians with special training in invasive image-guided techniques in infants and children. Children's Hospital Boston pediatric anesthesiologists, radiologic technologists and nurses are trained and experienced in the care of children undergoing these procedures. The Department of Radiology at Children's Hospital Boston is equipped with modern ultrasound and x-ray equipment as well as pediatric catheters and other equipment appropriate for performing this procedure.
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Indications for percutaneous nephrostomy include obstructions or blockages of the renal collecting system (part of the urinary tract draining the urine between the kidney and bladder), with or without associated infection. Specific diagnoses include hydronephrosis, ureteropelvic junction obstruction, and ureterovesical junction obstruction.
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The technique of percutaneous nephrostomy, when performed by an appropriately trained and experienced interventional radiologist, is a safe technique. Like any other invasive procedure, certain complications and side effects can occur. These will be explained to you in detail before you give your consent. There may be some discomfort associated with the initial placement of the needle and this is minimized by the administration of general anesthesia or sedation medication and by injection of local anesthetic (numbing medication) into the skin prior to placing the needle.
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You will be given detailed instructions regarding time and place of arrival and dietary preparation. In general, percutaneous nephrostomy is performed after the patient has eaten no solid food for eight hours and no clear fluids in the three hours prior to the procedure.
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You will be given detailed instructions regarding time and place of arrival and dietary preparation. In general, percutaneous nephrostomy is performed after the patient has eaten no solid food for eight hours and no clear fluids in the three hours prior to the procedure.
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You will be asked to lie prone (on your stomach) on an x-ray table. The interventional radiologist will examine your kidneys with an ultrasound probe. Once you are relaxed, the skin on your back will be washed with a special iodine solution and sterile drapes will be placed over you to prevent infection. After injection of the local anesthesia (numbing medicine), the interventional radiologist will, using the ultrasound probe for guidance, pass the needle directly into the collecting system of the kidney. This needle can be used to inject contrast medium to highlight the collecting system inside the kidney on the x-ray monitor images. The needle will then be exchanged for a catheter for drainage of urine. This catheter can be connected to a collection bag and kept in place until the cause of the obstruction to urine drainage has resolved. The catheter can also be used to introduce special catheters or instruments for balloon dilation of narrowed areas within the ureter or removal of kidney stones.
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Ultrasound guidance allows the interventional radiologist to see the best course for passage of a needle from the skin, through the kidney, into the fluid containing structures inside the kidney. Once the needle or catheter has been placed inside the kidney and contrast medium is injected, the resulting x-ray images show the collecting system inside the kidney. The radiologist can then determine whether the collecting system is blocked, and if so, exactly where the obstruction is. Once the nephrostomy catheter is in place, the urine can flow out of the kidney through the catheter, relieving the pressure in the kidney. The urine drained through the catheter can also be sent for tests to determine whether an infection is present, and to determine the best antibiotic medication. In certain cases, the catheter can be used to infuse antibiotics and other drugs directly into the kidney. As described above, some obstructions can be treated through the catheter by inflating a balloon across the obstruction and stretching the obstructed area. The x-ray pictures can then be repeated to see whether or not the obstruction has been improved.
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The interventional radiologist will discuss the findings and results of this test with you immediately after the procedure.
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Further information can be obtained by calling Children's Interventional Radiology Office at 617-355-6579. The appropriate person will return your call.
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