Percutaneous nephrostomy was performed for a range of indications in obstructive uropathy because of benign and malignant tumors. Percutaneous nephrostomy was performed by using ultrasound guided procedure are those are effective, safe, easy and effective.
PROCEDURE:
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The percutaneous nephrostomy was performed completely under ultrasound guidance as soon as it was probable in emergency.
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The patient was placed in prone position on the ultrasound table and a pillow kept under the abdomen on sides to be operated to correct lumbar lordosis and support the kidney.
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Ultrasound scanning was done by using a 7.5 MHz transducer to acquire a median longitudinal scan through the kidney. After the initial puncture site was chosen, then it was cleaned and draped.
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After that local anesthesia was performed at the punctured site and surround by using 3-5 ml of 1% lignocaine. Sterilized betadine jelly was used to the transducer and localization of the puncture site was performed again.
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The fascia and skin were incised with a #11 blade and then the scanning head was shift over the cut to measure the space between the skin and the calyx. An 18G-sheathed needle was introduced blindly through that cut and aimed at the direction earlier determined by the ultrasound.
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The sonographic view as well as urine established that the needle was at the desired site. The needle was then removed by leaving a small catheter in the same place and a curved J tip 0.038 guide wire was introduced into the collecting system by the puncture needle.
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Once the guide wire is in location, the fascial dilators was introduced along with rotating movements through advancement.
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The tract was dilated 2F above the desired catheter to be placed, after tract dilation a polyethylene pigtail catheter was inserted over the guide wire. The pigtail catheter was carefully sutured to the skin by using silk 1-0 after that adhesive strapping was done.
