Nephrostomy

Nephrostomy is primarily indicated for the relief of urinary tract obstruction, which accounts for 85-90% of all nephrostomy placements.¹ The three most common causes of renal obstruction in adults are urinary stones, malignancy, and iatrogenic benign stricture.²

Patient selection criteria include those with benign or malignant conditions causing urinary obstruction where surgeons have a plan for resolution once the immediate threat has been addressed.¹ The most urgent indication is an acutely obstructed and infected urinary tract (pyonephrosis, obstructive pyelonephritis, or urosepsis), which can be life-threatening.³

The surgical procedure begins with cross-sectional diagnostic imaging (ultrasonography or computed tomography) to confirm obstruction and identify pathology.² Under local anesthesia and sedation, a needle is inserted through the skin into the kidney’s collecting system, followed by placement of a drainage catheter.¹ This allows for minimally invasive decompression of the obstructed kidney and permits specimen collection for diagnostic purposes.³

Expected outcomes include immediate relief of obstruction and preservation of renal function. Complete renal function recovery is likely even with complete mechanical obstruction for up to one week, with diminishing recovery rates beyond that timeframe.¹ Long-term nephrostomy may be necessary in cases of permanent obstruction, though it carries certain morbidities that must be considered.⁴