Nephrostomy care - Causes, symptoms and treatment. MF.
Mar 28, 2018
A nephrostome is a special tube that is inserted into the cavity of the renal pelvis for urinary outflow after an operation on the kidney or ureter. The task of nephrostomy is the effective evacuation of urine from the kidney cavity, while the ureter and bladder are not yet ready to actively excrete urine.
There are two methods of setting a nephrostomy. At the first it is made during the operative intervention, and at the second - with the help of percutaneous puncture of the renal pelvis. In principle, the setting of a nephrostomy is an exclusively medical manipulation, and the patient takes only passive participation in it. As a rule, nephrostomy is established in such pathological conditions as urolithiasis, ureteral tumors or obstruction. In this case, it can have both a therapeutic and diagnostic purpose. For example, in purulent kidney diseases, nephrostomy is often performed in order to take the contents of her pelvis for analysis.
Appearance of nephrostomy
Timing of setting of nephrostomy
As a rule, the time of setting the nephrostomy is quite large. For example, if a patient is operated for urolithiasis, his nephrostomy period can last up to six months, during which it is necessary to carefully monitor and take care of the tube. In other pathologies, for example, with partial obstruction of the ureter with concrement, the duration of the nephrostomy can not exceed one month. However, in such situations, urologists try not to burden patients with catheter placement and do not perform this procedure, replacing it with other, more sparing methods of treatment.
Transcutaneous setting of nephrostomy
Care for nephrostomy
Care for the nephrostomy tube, regardless of the timing of the latter, should always be as thorough as possible. On this depends not only the condition of the patient during treatment, but also the timing of his final rehabilitation. There are several simple rules for caring for the nephrostomy:
1. Ideal purity around the puncture wound .In any case, the wound, whatever it may be, is the source of infection into the human body. Puncture wound with nephrostomy is no exception. And in order to prevent the penetration of the infection along this path, it is necessary to thoroughly and daily treat the puncture wound with solutions of antiseptics and perform sterile dressings. As antiseptics, you can use drugs such as chlorhexidine or a solution of furicillin. And for bandages at home, you need to buy a sterile bandage or gauze cut.
2. Regular evacuation of the urinal. At its core, the nephrostomy tube is a tube through which urine enters a special reservoir, called the urine collection. In fact, it is an ordinary polyethylene bag that has a hermetic clasp. Each of the urinals has a special label that indicates the level of urine that requires replacement of the urine collection. Untimely replacement of the reservoir threatens the patient with a reverse transfer of urine into the cavity of the renal pelvis. This can have a double negative effect. First, increased pressure in the renal pelvis may affect the tightness of the surgical sutures, and secondly, the reverse throw of urine is always dangerous by infection of the kidney.
3. Permanent washing of the kidney .As a rule, a passive outflow of a nephrostome is not always enough to ensure good circulation in the pelvis. Therefore, in regard to the nephrostomy periodically it is necessary to use active drainage. Especially for this, in the cavity of the renal pelvis during the puncture is established not one, but two tubes. By actively feeding the antiseptic into one of the tubes, a wash liquid containing stagnant urine with sand residues can be obtained from the second one. Urologists recommend that you perform this procedure approximately once a week for the duration of the nephrostomy.
Possible complications of nephrostomy
The first group of complications caused by a nephrostomy is related to the procedure for the placement of this catheter. For example, if a percutaneous approach is used to stitch a nephrostomy, the artery near the kidney can be damaged during the last needle. This will lead to a serious hemorrhage in the retroperitoneal tissue and the formation of retroperitoneal hematoma. This clinical situation is dangerous because the hematoma can not resolve, but become infected, which will lead to unavoidable surgical intervention on the retroperitoneal space. In addition, if despite hematoma, nevertheless, access to the renal pelvis will be performed, this may result in the appearance of blood in the urine, which can lead to an incorrect diagnosis and the appointment of an incorrect treatment.
The second group of complications that can accompany nephrostomy is kidney infection. Secondary postoperative pyelonephritis, which at the same time develops, has a very aggressive course and poorly yields to standard antibiotic treatment. To correct the arisen pathology, it is necessary to use powerful modern antibacterial agents that are not very cheap. This is why it is better to warn the named pathology than to treat it.
Rev.the doctor the urologist, the sexologist-andrologist Plotnikov А.N.