Percutaneous Nephrostomy

A percutaneous nephrostomy is performed when there is blockage or obstruction in the part of the urinary tract draining the urine between the kidneys and bladder. This part of the urinary tract is called the renal collecting system.

During this procedure, a catheter is placed through the kidney into the renal collecting system. The placement of the catheter is done under image guidance, which means that images or pictures taken through ultrasound and x-ray are used to guide the placement of the catheter.

Indications for percutaneous nephrostomy include obstructions or blockages of the renal collecting system, with or without associated infection. Specific diagnoses include:

• hydronephrosis
• ureteropelvic junction obstruction
• ureterovesical junction obstruction

You will be given detailed instructions regarding time and place of arrival and dietary preparation.

Some children may need to have an appointment in the pre-op clinic.

• You will meet with the pre-op nurse, anesthesiologist, and interventional radiology nurse practitioner.
• Laboratory testing may be done.
• Additional testing may be needed depending on your child’s history.
• Please plan on at least two to four hours for the pre-op visit.

Your child may receive general anesthesia to help him stay still during the procedure. General anesthesia is medicine that causes deep sleep. The anesthesiologist will discuss this with you and obtain consent, either the day of the procedure or at a scheduled pre-operative visit.

Explain in simple terms why the procedure is needed and what will happen.

• Assure your child that you will be close by during the procedure.
• Your child may bring a favorite toy or blanket into the room.

A staff person from Admitting, Day Surgery, or our Preoperative Clinic will call you a few days before the procedure to tell you where to go when you come to the hospital.

• When you arrive, the interventional radiologist will talk with you about the procedure and ask you to sign a consent form. You must be your child’s legal guardian to sign this form. If you are a legal guardian and not a parent, you must bring legal paperwork with you showing proof of legal guardianship.
• Your child will change into a hospital gown.
• A nurse or anesthesiologist may start an intravenous (IV).
• You and your child will be brought into the room where the procedure is done. The nurse or the anesthesiologist will give some medicine through the IV to help your child relax. You may stay until your child falls asleep.
• If your child is young, he may go to sleep with medicine and a mask.
• You will be waiting in a special area until your child’s procedure is done and he is settled in the post-anesthesia care unit (PACU).

• Your child will be asked to lie prone (on his stomach) on an x-ray table.
• The interventional radiologist will examine your child’s kidneys with an ultrasound probe.
• Once your child is sedated or under general anesthesia, the skin on his back will be washed with a special iodine solution.
• Sterile drapes will be placed over your child to prevent infection.
• After injection of the local anesthesia (numbing medicine), the interventional radiologist will pass a needle directly into the collecting system of the kidney, using the ultrasound probe for guidance. 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.
• This needle is used to inject contrast medium to highlight the collecting system inside the kidney on the x-ray monitor images. The radiologist can then determine whether the collecting system is blocked, and if so, exactly where the obstruction is.
• The needle will then be exchanged for a catheter. Once the 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.

• A nurse will take your child to the Interventional Radiology Post-Anesthesia Care Unit (PACU). You will be allowed to come to the recovery area.
• The nurse will monitor your child closely until your child is admitted or returned to his hospital bed.
• The interventional radiologist will speak with you about the procedure.

Percutaneous nephrostomy, when performed by an appropriately trained and experienced interventional radiologist, is a safe procedure that can usually be performed under sedation. As with all invasive procedures, complications and side effects may occur. These will be explained to you in detail before you give your consent.

Your child will be exposed to ionizing radiation (x-rays) during the procedure. We believe that the benefit to your child’s health outweighs the exposure that occurs during the percutaneous nephrostomy. Because children are more sensitive to radiation exposure than adults, we have been leaders in adjusting equipment and procedures to deliver the lowest possible dose to young patients.

The interventional radiologist will inform you of the results immediately after the procedure. If you have any questions, please speak to your child’s doctor.