Percutaneous nephrostomy, antegrade stent placement, and radiological control of post-pcnl bleeding

Abstract

Percutaneous nephrostomy is a well-established technique for relief of obstruction of the renal outflow tract. The technique can be extended into nephrolithotomy for stone removal, nephroscopy, ureteroscopy, and antegrade ureteral stent placement. Serious vascular complication can be avoided by entering the pelvicalyceal system from relatively avascular area under radiological guidance. The puncture site can be from the lower pole, interpolar region, or upper pole, depending on the indication for which nephrostomy is being performed. Appropriate entry requires proper visualization of the collecting system, which is optimum whenever there is hydronephrosis. Puncturing a nondilated system is difficult and associated with a higher complication rate.Transient hematuria, which is mostly managed conservatively, occurs in virtually every patient after percutaneous nephrostomy; however, severe bleeding that may require transfusion or intervention is uncommon. Other complications that may be seen include urosepsis, which can be avoided by minimal manipulation and protective antibiotic cover.Knowledge of basic technique of nephrostomy and its complications is therefore very important; it allows the operator to extend the technique with safety, whenever required.