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What Is A Percutaneous Nephrostomy Used For?

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Percutaneous Nephrostomy Sets

Introduction


Nephrostomy is a high-level urinary diversion method that has important uses in urology. Nephrostomy is a stand-alone surgery in itself, but is sometimes performed after other surgeries on the kidney, such as pyeloplasty. Nephrostomy is an emergency measure in cases of pyonephrosis. At present, due to the development of urological endoscopic technology, nephrostomy has evolved from solving the problem of renal pelvic drainage to percutaneous nephrostomy lithotripsy and stone removal. Through nephrostomy drainage, contrast examination can be performed during the treatment of extracorporeal shock wave lithotripsy to determine The location of the stone, and the indwelling nephrostomy tube can make the gravel easily excreted from the body after ESWL treatment, prevent the stone from blocking the ureter, and can perform percutaneous nephrostomy lithotripsy again, becoming an auxiliary method in stone treatment.



Nephrostomy can be divided into permanent nephrostomy and temporary nephrostomy according to the time and purpose of indwelling the stoma tube. Temporary nephrostomy is often used clinically. Temporary nephrostomy is often completed after kidney and renal pelvic surgery to improve renal drainage and increase the success rate of surgery. It can also be used to correct hydrops or infection in the vertical pelvis to improve kidney function and the patient's general condition. For patients with poor physical fitness and intolerance For patients undergoing complex surgery, this transitional treatment can create conditions for definitive treatment. Permanent nephrostomy is a palliative surgery. If the ureter is blocked by a tumor and the tumor cannot be removed, or if the ureter is severely damaged and loses its function due to extensive ureteral stenosis due to radiation damage, a permanent nephrostomy is required.



Nephrostomy can be divided into percutaneous nephrostomy according to its surgical method; in situ nephrostomy exposed through the waist without freeing the kidney, and free nephrostomy. Renal puncture stoma has less damage and the method is relatively simple, but its drainage effect is affected by the inability to ensure the proper position of the stoma tube. Careless operation may cause damage to renal blood vessels, pleura, etc. Nephrostomy is only suitable for cases with thin renal cortex and severe hydrops. In situ nephrostomy is completed under direct vision with little damage and can be completed under local anesthesia. It is a common method for simple nephrostomy. Free nephrostomy is often done after other upper urinary tract surgeries.



Indications


1.Those with obstructive lesions in the solitary kidney and urinary obstruction.

2.Those with severe hydronephrosis, poor renal function, and unable to tolerate complex surgical treatment.

3.In severe pyonephrosis, drainage of renal pus will help improve the patient's poisoning symptoms and facilitate subsequent treatment.

4.After surgery for kidney or ureteral disease, it can be used as a temporary diversion of urinary flow, which is beneficial to wound healing.

5.When obstructive disease (malignant tumor) occurs in the lower ends of the bilateral ureters or bladder and cannot be cured.

6.When certain renal cast stones are treated with percutaneous nephrostomy lithotripsy and ESWL.



Preoperative preparation


1.For critically ill patients, active measures should be taken to improve the patient's systemic condition, such as correcting anemia, treating sepsis, uremia, correcting water, electrolyte, and acid-base balance imbalances, etc. This is important for emergency nephrostomy patients.


2.Choose the appropriate stoma method according to the disease condition and the patient's systemic tolerance. For patients with renal pelvic separation <3cm, percutaneous renal puncture is difficult, and in situ nephrostomy or free nephrostomy should be used.


3.Use antibiotics to prevent and treat infections.



Anesthesia and positioning


Local infiltration of anesthesia or epidural anesthesia, general anesthesia can also be used. Local anesthesia is often used for renal puncture and stoma. Side decubitus position.

The prone position can also be used for puncture stoma.



Postoperative treatment


1.Connect the stoma tube to the bedside disinfection and drainage device, and protect the stoma tube to prevent it from falling out or twisting into an angle. Drainage devices should be sterile and clean, and should be replaced regularly.


2.Keep the stoma tube unobstructed. If drainage is not smooth, use normal saline to flush the stoma tube. In cases of obvious hematuria, renal pelvis infection, and excessive urine sediment, isotonic saline or other flushing fluids are needed for renal pelvic flushing to keep the stoma tube unobstructed, and attention should be paid to aseptic operation during flushing.


3.Encourage the patient to drink more fluids or give intravenous fluids.


4.Use antibiotics to prevent and treat infections.


5.The rubber drainage tube should be removed within 3 to 4 days after surgery.


6.For those who need long-term drainage, the first replacement of the ostomy tube can be performed 3 to 4 weeks after the operation. When replacing the ostomy tube, it is recommended to prepare two ostomy tubes (one tube diameter is equivalent to the original ostomy tube, and the other The diameter of the stoma tube is slightly smaller than that of the original stoma tube). When pulling out the original stoma tube, the prepared stoma tube should be placed immediately and the insertion depth should be the same as the original tube. Immediately check the patency of the drainage tube after replacing the stoma tube.



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