Percutaneous nephrostomy

Percutaneous nephrostomy (PCN) refers to creating an opening through the skin into the renal pelvis, allowing urine to drain directly from the pelvis into a urinary collection bag. The procedure is guided by ultrasound. In case of hydronephrosis with pyelonephritis, PCN must be performed emergently to allow drainage of the infected urine. The most common indication for PCN is a need for urinary drainage which cannot be achieved otherwise.

• Indications
  • Complete urinary tract obstruction causing hydronephrosis
  • Hydronephrosis with pyelonephritis (also called obstructive pyelonephritis or pyonephrosis)
  • Allowing the ureter to heal in case of injury or severe haemorrhagic cystitis
• Procedure
  • A needle is advanced through the flank into the collecting system
  • Urine is aspirated
  • A guidewire is inserted through the needle
  • The needle is removed
  • The lumen is enlarged by passing dilators over the guidewire
  • Once the lumen is large enough a pigtail catheter is placed

Percutaneous nephrolithotomy

Percutaneous nephrolithotomy is a procedure for treating kidney stones where a percutaneous nephrostomy is created and instruments are led through the opening and into the renal pelvis. These instruments allow for collection, vaporisation (with laser) or crushing of the stone.

Indications:

• Stones which cannot be removed by other measures
• Pregnant people with kidney stone that must be removed
• Staghorn calculi