Percutaneous Nephrostomy Drainage Procedure Treatment Cost in India

Percutaneous nephrostomy is a minimally invasive procedure used to drain urine from the kidney when normal urine flow is obstructed. A needle is inserted through the skin and kidney under imaging guidance. A catheter is then passed through the needle into the renal pelvis, allowing urine to drain into an external collection bag. This procedure is commonly used to relieve urinary tract obstruction caused by conditions such as kidney stones, tumors, or ureteral strictures. Depending on the underlying condition, it provides temporary or long-term relief and can improve kidney function and alleviate symptoms associated with urinary obstruction.

Why Do You Need Percutaneous Nephrostomy & Drainage?

Percutaneous nephrostomy and drainage are necessary when a blockage in the urinary tract prevents normal urine flow from the kidney to the bladder. This obstruction can result from various conditions such as kidney stones, tumors, ureteral strictures, or congenital abnormalities. Here's why percutaneous nephrostomy and drainage are needed:

• Relief of Urinary Obstruction: The procedure bypasses the obstructed portion of the urinary tract, allowing urine to drain directly from the kidney into an external collection bag. This relieves pressure on the kidney and urinary system, preventing complications such as hydronephrosis (swelling of the kidney) and kidney damage.
• Management of Kidney Stones: Percutaneous nephrostomy is commonly used to drain urine from the kidney when a large kidney stone obstructs the urinary tract. It provides a route for accessing and fragmenting the stone using extracorporeal shock wave lithotripsy (ESWL) or laser lithotripsy.
• Treatment of Urinary Tract Infections: Drainage of infected urine from the kidney can help treat and prevent urinary tract infections (UTIs) associated with urinary obstruction. By removing stagnant urine that harbors bacteria, percutaneous nephrostomy reduces the risk of recurrent infections and sepsis.
• Preparation for Surgical Intervention: In cases where definitive treatment, such as ureteroscopy or nephrolithotomy, is required to remove the obstruction, percutaneous nephrostomy provides temporary drainage and prepares the patient for subsequent surgical procedures.

Types of Percutaneous Nephrostomy & Drainage

Percutaneous nephrostomy and drainage encompass various techniques and approaches tailored to the specific needs of patients with obstructive uropathy or other urinary tract disorders. Here are the types of percutaneous nephrostomy and drainage:

• Standard Percutaneous Nephrostomy: A needle is inserted percutaneously through the skin and into the renal collecting system under imaging guidance. A guide wire is then advanced through the needle into the renal pelvis, followed by dilation of the tract using serial dilators. A nephrostomy tube is finally inserted over the guide wire, allowing urine to drain externally into a collection bag
• Ultrasound-guided Percutaneous Nephrostomy: This approach utilizes real-time ultrasound imaging to guide needle insertion and tract dilation. Ultrasound guidance offers advantages in patients with challenging anatomy or in situations where fluoroscopy may not be readily available.
• Fluoroscopy-guided Percutaneous Nephrostomy: Fluoroscopic guidance involves using X-ray imaging to visualize the urinary tract anatomy and guide needle placement, tract dilation, and nephrostomy tube insertion. Fluoroscopy allows for precise localization of the renal collecting system and accurate placement of the nephrostomy tube.
• Antegrade Nephrostomy vs. Retrograde Nephrostomy: Antegrade nephrostomy involves accessing the renal collecting system through the kidney cortex, whereas retrograde nephrostomy accesses the renal pelvis via the ureter using a retrograde ureteral catheterization technique.
• Balloon Dilation Nephrostomy: In some cases, balloon dilation may dilate the tract after initial needle insertion, facilitating the insertion of larger nephrostomy tubes or stent placement.

How Patients are Selected for the Procedure? 

Selecting patients for percutaneous nephrostomy and drainage involves a comprehensive evaluation by a multidisciplinary team comprising interventional radiologists, urologists, nephrologists, and other specialists. Several factors influence the decision-making process:

• Urinary Obstruction: Patients with obstructive uropathy due to conditions such as kidney stones, tumors, ureteral strictures, or congenital abnormalities may require percutaneous nephrostomy and drainage to relieve urinary obstruction.
• Imaging Studies: Diagnostic imaging, such as ultrasound, CT scans, or MRI, is crucial for assessing the anatomy of the urinary tract, identifying the location and severity of obstruction, and determining the feasibility of percutaneous access to the renal collecting system.
• Renal Function: Evaluation of renal function, including serum creatinine levels and estimated glomerular filtration rate (eGFR), helps assess the degree of kidney dysfunction and guide treatment decisions. Patients with compromised renal function may benefit from prompt drainage to prevent further deterioration.
• Clinical Presentation: Patients presenting with symptoms such as flank pain, hematuria, renal failure, or signs of sepsis due to urinary obstruction may require urgent intervention with percutaneous nephrostomy to alleviate symptoms and prevent complications.
• Comorbidity Evaluation: Assessing comorbid conditions such as cardiovascular disease, coagulopathy, or infection is essential to evaluating the patient's overall risk profile and guiding treatment decisions.
• Patient Preferences: Patient preferences, goals of care, and treatment expectations play a significant role in the decision-making process. Shared decision-making between patients and healthcare providers ensures that treatment plans align with patients' values and preferences.