Nephrostoma in the kidney, under what conditions is required, contraindications
A kidney nephrostomy is the creation of a communication channel between the body surface and the renal pelvis. A drainage tube stretches along this channel, which helps to realize urine drainage from the pelvis. A nephrostome is superimposed in the case of a violation of urinary diversion through the natural urinary canals, with purulent pyelonephritis, with acute hydronephrosis or after kidney surgery.
As a rule, the nephrostomy is superimposed after the removal of coral stones in the kidneys, with damage to the kidneys and ureter, with improper discharge of urine due to the formation of the tumor.
The purpose of manipulation of
The main goal of nephrostomy for patients with oncological pathologies is the restoration of urinary excretion from the kidneys during the formation of a tumor in the small pelvis, concomitant oncology and urolithiasis, with ureteric stricture or with peritoneal disease metastases or tumor pressure on the ureters.
Restoration of normal outflow of urine makes it possible to prevent damage to the body by hydronephrosis, pyelonephritis and acute renal insufficiency.
In some patients, the nephrostomy is used to gain access to the upper urinary tract, the implementation of chemotherapy, and to prepare the patient for subsequent surgery. Sometimes nephrostomy is carried out for the organization of a special examination.
Contraindications of nephrostomy
The main contraindications for nephrostomy are:
- Blood clotting disorders - tamocytopenia, hemophilia, etc.
- Uncontrolled increase in blood pressure.
- The use of anticoagulants - heparin, aspirin, etc.
Preparatory phase of
Before the beginning of nephrostomy, it is first necessary to submit a list of analyzes - general urine tests, blood tests, biochemical blood tests, urine culture for bacterial flora. In addition, an ultrasound examination of the kidneys. Sometimes it is necessary to organize intravenous and review urography, CT of kidneys and space behind the peritoneum. Sometimes, before the nephrostomy, additional instrumental examinations are required.
Carrying out nephrostomy
In medical practice, nephrostomy is usually achieved through percutaneous puncture when accompanied by X-rays or ultrasound. The procedure is carried out in the conditions of a special operating room and with the introduction of intravenous anesthesia. Also, sometimes nephrostomy is performed during an open or laparoscopic operation in the formation of a tumor or a kidney cyst with damage to the kidney cortex alone.
Puncture percutaneous nephrostomy involves a puncture of soft tissue in the lumbar region and the injection of a puncture needle into the pelvis of the kidney. In the formed puncture rope, a catheter is inserted that connects to the urine collection.
Care after nephrostomy
For the prevention of urinary tract infections and the subsequent long-term functioning of an established nephrostomy, regular drainage with a sterile physiological solution is necessary. In addition, it is desirable to constantly replace nephrostomy - rennefrostoma. It should be realized not later than the first day in the event of a drop in the drainage tube or when it is clogged with salts that are part of the urine.
Removal of the nephrostomy
The removal of the nephrostomy is performed after the restoration of the correct urinary diversion through the channels of urination is completed against the background of ongoing surgical treatment or chemotherapy. Before removing the nephrostomy, urinary tract can be checked for patency by inserting a special dye into the drainage tube. Usually nephrostomy drainage is removed two to three weeks after surgery.
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