Retrograde nephrostomy: advantages, disadvantages, and the learning curve

Establishment of a nephrostomy tract is a prerequisite for many endourologic procedures of the upper urinary tract. We reviewed our initial experience with 31 retrograde nephrostomies to determine the advantages and disadvantages and the learning curve for the procedure. All but one of the attempts were successful, and no complications were attributable to the nephrostomy puncture. The procedure time averaged 21.1 minutes in nondilated collecting systems but 32.0 minutes in hydronephrotic kidneys (P < 0.01). The mean procedure time in our first 10 successful cases was 36.2 minutes, but it decreased to 22.6 minutes in the second 10 successful cases (P < 0.02). Radiation exposure was also minimized early, with a mean fluoroscopy time of 3.5 minutes in our first 10 successful cases and 1.5 minutes in our second 10 successful cases (P < 0.02). Similarly, both procedure and fluoroscopy times decreased further in the most recent 10 successful cases. Retrograde nephrostomy is a safe procedure, is easier in a nondilated collecting system, and can be mastered with a short learning curve with minimal radiation exposure.