Saving kidneys with bilateral block
Lack of urine and rapid rise in creatinine with bilateral obstruction require drainage within hours. Both kidneys are punctured under ultrasound sequentially, the patient lies on his stomach, in severe condition - on his side with sedation. After restoration of the outflow in the first day, polyuria often develops - the outflow of a large volume of urine, which requires control of electrolytes and infusion. Further tactics depend on the cause: for tumors, they try to replace nephrostomies with internal stents, for stones, they perform lithotripsy on both sides.
Indications
- obstruction of the ureter by a stone with kidney infection (obstructive pyelonephritis) - urgently;
- hydronephrosis due to compression of the ureter by a tumor (cancer of the cervix, prostate, bladder, retroperitoneal tumors);
- kidney block, when it is not possible to install an internal stent;
- acute renal failure due to bilateral outflow obstruction;
- urinary fistulas and damage to the ureter after surgery - for urine diversion;
- the first stage before percutaneous nephrolithotripsy for coral stones with infection;
- pyonephrosis (purulent kidney) for drainage and stabilization before surgery.
How it goes
The patient lies on his stomach or side. The skin of the lower back is treated and numbed with a local anesthetic; for severe pain, sedation is added. Under ultrasound control, the doctor punctures the dilated calyx of the kidney with a thin needle - when urine appears, a conductor is inserted through the needle, the canal is gradually expanded, and a nephrostomy drainage with a diameter of 3-4 mm is installed with a fixation curl in the pelvis. Contrast X-ray confirms the position. The tube is sutured to the skin and connected to a urinal. The entire procedure takes 20–30 minutes; with bilateral nephrostomy - twice as long.
Nephrostomy replacement is performed on an outpatient basis using a guide in 10–15 minutes: the old tube is removed and a new one is installed along its channel. When the canal narrows, it is first bougienage.
Nephrostomy care
The skin around the tube is treated daily with an antiseptic and covered with a sterile bandage; The urinal bag is changed once a week and emptied as it is full, avoiding kinks in the tube. Rinsing the drainage with a sterile solution is performed only as prescribed by a doctor. It is important to monitor the amount and color of urine: a sharp decrease, blood, leakage past the tube or temperature is a reason to contact the clinic. Showering is allowed with headband protection, baths and swimming pools are not. A nephrostomy that has been in place for longer than 2–3 months is routinely replaced, as the tube is encrusted with salts.
What's next
Nephrostomy is a temporary measure that saves the kidney and relieves the infection. After stabilization of the condition, the cause is eliminated: the stone is crushed (ESWL, contact or percutaneous lithotripsy), the stricture is operated on, an internal stent is installed for tumors, or the issue of treatment is decided. After removing the obstacle, the nephrostomy is clamped for 1–2 days, the outflow is checked by ultrasound and removed - the fistula tract closes on its own within a few days.
Nephrostomy in Tashkent
In the clinics below, percutaneous nephrostomy is performed under ultrasound and X-ray control, including urgently around the clock for obstructive pyelonephritis, as well as outpatient nephrostomy replacement and fistula bougienage. Prices according to the clinic’s price list for one- and two-way procedures. If you have lower back pain with fever and decreased urination, contact us immediately.
