[Ultrasound-guided percutaneous nephrostomy]

Area of Science:

• Urology
• Minimally Invasive Surgery
• Medical Imaging

Background:

• Percutaneous nephrostomy is a vital mini-invasive technique for creating an external renal excretory tract.
• Indications range from diagnostic to therapeutic purposes.
• Ultrasound (US) guidance is preferred for its ability to visualize renal anatomy and is safe in pregnancy and for patients with contrast allergies or renal dysfunction.

Purpose of the Study:

• To detail the technique and considerations for percutaneous nephrostomy.
• To highlight the advantages of ultrasound guidance and its combination with fluoroscopy.
• To describe optimal access points and catheter materials for successful procedures.

Main Methods:

• Procedures are typically guided by ultrasound (US), often combined with fluoroscopy for enhanced accuracy (over 98% success rate).
• Access is generally posterior, targeting Broedel's avascular plane in the inferior calyx.
• Techniques include Seldinger's, one-step, or mixed access, with a preference for direct US-guided puncture using an 18 G needle.

Main Results:

• Ultrasound provides excellent visualization of renal cavities and depth, crucial for safe catheter placement.
• Combining US with fluoroscopy significantly increases procedural success rates.
• Careful attention to guide wire manipulation and catheter material (e.g., polyurethane) is essential to avoid complications and ensure smooth insertion.

Conclusions:

• Percutaneous nephrostomy is a safe and effective procedure when performed with appropriate guidance and technique.
• Ultrasound guidance, particularly when augmented by fluoroscopy, offers superior safety and efficacy.
• Optimal selection of access site, needle, guide wire, and catheter material contributes to successful outcomes.