Very often, patients are referred to specialists who have a tumor like oncology of the breast or rectum with metastasis to the lymph system. Treatment is possible and has chances of success, surgical interventions can not be carried out, since tumor formation or a metastatic lymph node caused the compression of the ureters, which led to a violation of the urine flow. In fact, to restore the urinary flow it is necessary to eliminate the lymph node or tumor, but this can not be done, since the violation of the urinary flow caused the kidney failure in the patient. It is in such cases that the clinical situation is saved by nephrostomy.
Nephrostomy
Nephrostomy is an operative procedure performed to remove urine from the kidney with a special device in the form of a tube. Nephrostomy is performed with mandatory monitoring of ultrasound or radiographic equipment. Usually, the setting of the nephrostomy is prescribed in cases where the ureteral canal is blocked, which leads to the forced accumulation of urine in the patient's pelvic apparatus.
A special tube of urine flows from the kidney into a sterile receiver. Nephrostomy can also be given if one or both kidneys fail to function. This surgical intervention is important because it helps to prevent irreversible destruction occurring in the kidney structures against the background of urinary drainage disorders. Most often in such an intervention, cancer patients are needed. When the functionality of the organ is restored, drainage is removed, and with irreversible damage to the kidney structures, the catheter can be left permanently.
Indications
For the intervention, a number of specific medical indications have been identified:
- To prepare for surgical intervention;
- For lithotripsy, i.e., crushing calculi in the kidneys;
- For special inquiries;
- For chemotherapeutic treatment;
- For stenting;
- With narrowing of the ureter;
- In neoplasms in renal tissues or other malotazovyh organs of a malignant or benign character;
- With hydronephrosis, when there is an expansion of the cup-and-pelvis system;
- In the presence of concrements in the bladder, ureters or kidneys.
In addition, nephrostomy acts as an effective preventive measure for the onset of a pathology such as hydronephrosis.
Types of
In practice, several methods of catheter placement are used:
- Puncture percutaneous technique or percutaneous setting;
- Open or intraoperative technique.
When the method is open, a full-fledged surgical intervention is performed, and in the puncture technique the tube is injected through a small skin puncture. The needle penetrates the kidney into the pelvis and a catheter is inserted into the resulting canal, which joins the urine collection. Puncture technique is considered less invasive and safe, has no complications and does not require rehabilitation.
Preparing for operation
Preoperative preparation practically does not differ from the standard preparation for any other operation. The patient undergoes a comprehensive examination and passes the prescribed tests. Additionally, studies are carried out on sugar and bakosev on flora, biochemistry and coagulogram. If no contraindications were found during the studies, an X-ray and ultrasound diagnosis of the kidneys is performed to determine the extent of the disorders, the volume of accumulated urine, etc.
Urography, CT of retroperitoneal space and kidneys are then prescribed. The patient is necessarily examined by a gynecologist, his reaction to anesthetic drugs and anesthesia is assessed. If the patient showed a urinary bladder, antibiotic therapy is prescribed to stop inflammatory lesions.
Contraindications
The procedure has a number of contraindications, which specialists necessarily take into account when assigning such a procedure.
Nephrostomy contraindicated:
- With non-refractory adjustment of hypertension;
- When applying blood-thinning medications and anticoagulants like Heparin or aspirin. It is necessary to stop the course of therapy one week before the scheduled surgery;
- In the presence of blood pathologies such as hemophilia, thrombocytopenia, etc.
Technique of operation
If the intervention is carried out in an open way, then the system for nephrostomy is established using a kidney cavity operation. In the zone of the waist, the surgeon makes a cut to the kidney. When he gets to the fatty capsule, it is sewn to the skin by several stitches. Then the parenchyma and pelvis are cut and inserted into the rubber tube, which is also sewn to the skin. The rest of the cut is sewn.
In the puncture method of installing the kit for nephrostomy, a puncture is made in the area of the diseased kidney. All manipulations are controlled by ultrasound or radiology equipment. A puncture needle is inserted, and then a contrast is started to control the way the stoma ducts are installed. The outflow channel is usually sewn to the skin, although fixation options are possible with a balloon or a loophole loop. The duration of such an intervention does not exceed an hour, and the probability of complications is practically absent.
On the video technique of performing percutaneous nephrostomy:
Complications and rehabilitation period
After the operation, the patient is released home. Before this, the doctor must conduct a detailed briefing on how to care for drainage and avoid inflammatory complications.
- While the patient wears a catheter system, he will have to forget about any physical exertion, otherwise drainage may fall out;
- Strict compliance with a salt-free diet is necessary;
- Drainage and wound to avoid infection should be thoroughly and regularly washed using saline solution;
- With lifelong wearing of the catheter, it is periodically changed. Emergency replacement is necessary if the tube is clogged with urine salts.
In the first few days after the intervention, a small amount of bloody impurities in the urine is quite normal. At laboratory researches of urine results will show presence of erythrocytes.
With regard to complications, the primary relates directly to the installation and surgical intervention. So, in making a cut, there is a probability of damage to the perineal artery, which will provoke a profuse abdominal hemorrhage and the formation of retroperitoneal hematoma. She can become infected, then the situation will be saved only by surgery. Also, open interventions can be complicated by urinary leakage, infection, or bleeding.
When the recovery of normal urinary flow through the natural already existing channels occurs, the nephrostomy is removed. Experts preliminarily check the ability of the ureters to conduct urine. Usually, removal of the stoma is carried out after one and a half to two weeks. This time is enough to obtain positive results of treatment, unless the patient has irreversible destruction of the kidney tissues. The hole after the removal of the tube can be delayed 2-4 weeks.
For the operational procedure, a certain qualification is required, therefore, when contacting a private clinic, it is necessary to first study the patients' testimonials, get acquainted with specialists and make sure of their professionalism. Then the risk of complications will be excluded.