The kidneys are needed in order to provide one of the most important functions - the allocation of metabolic products from the body. If this is not done, a person may die from intoxication with their own metabolites.
In some cases, kidney function is difficult due to various pathological conditions. Among them are oncological formations, urolithiasis. In this case, blood filtration and absorption of beneficial elements occurs, but the final products are not excreted. And in order to establish this process, a nephrostomy is established.
What is it and in what cases is it necessary? Nephrostomy is a tube (drainage) connected to the pelvis of the kidney and brought out. It is needed to ensure the outflow of urine and prevent intoxication of the body.
Nephrostoma - what is it? Functions
As is known, in the case of cancer, it is not always possible to carry out a radical operation and at the same time maintain the functions of the organ. Sometimes tissue over a long stretch has to be completely removed to avoid the spread of cancer. In other cases, on the contrary, a radical operation is impossible due to severe disturbances in the body. To this end, palliative surgical interventions were invented. They do not lead to healing, but contribute to the restoration of the physiological capabilities of the body. Palliative operations are performed in all areas of oncology, and urological care is no exception.
So, to establish the excretory function of the body and save a person from endogenous intoxication, nephrostomy is performed. It consists in staging the drainage tube in the pyelocaliceal system of the kidney. The free end of the nephrostomy is brought out, that is, to the surface of the skin. A special container is connected to it, and the outflow of end metabolic products is carried out bypassing the bladder, ducts and urethra.
This operation refers to palliative care, so the doctor should think carefully about whether a particular patient needs a nephrostomy. What is it and how to care for it, he will explain to the patient before surgery. And the installation of renal drainage is performed only with the written consent of the patient or his relatives. In this case, it is necessary to assess the general condition of the patient and find out whether it is possible to carry out such an operation.
Indications for the delivery of nephrostomy
Like any artificially created drainage, a kidney nephrostomy performs a vital function. Most often, it is established for cancer of the genitourinary system. Less commonly, with other serious urological pathologies. There are special indications according to which a nephrostomy is established. An operation is performed if the following indications are available for nephrostomy:
- Cancer of the kidney or other organs of the urinary system.
- Hydronephrosis.
- Urolithiasis with a predominance of large calculi.
- Tumor metastases of any localization, compressing the pelvic organs.
- Ureteral ureter due to compression from the outside or strictures.
Nephrostomy helps not only to restore the outflow of fluid from the body, but also to prevent the onset of the inflammatory process. As a result, chronic and acute renal failure is avoided.
Such an operation does not always mean that artificial drainage will be in the body constantly. In some cases, after special treatment (surgery, chemotherapy), nephrostoma is removed. Sometimes the restoration of urine outflow is necessary for the duration of the diagnostic procedures (stenting).
Contraindications for nephrostomy
Despite the urgent need for surgery, nephrostomy can not always be performed. Contraindications include the following conditions:
- bleeding disorder;
- uncontrolled arterial hypertension;
- taking anticoagulants.
Diseases in which blood coagulation is impaired include hemophilia, hemorrhagic vasculitis, thrombocytopenic purpura, etc. With these pathologies, any surgical interventions are life-threatening. The same applies to taking anticoagulants - medicines that thin the blood. Nephrostoma is not established with high blood pressure, which is not amenable to medical correction. Surgery in this condition is contraindicated, because of the risk of stroke and cardiogenic shock.
Nephrostomy preparation
In cases of violation of the outflow of urine, which cannot be eliminated with the help of medications, a kidney nephrostomy is needed. The operation to install it, as a rule, does not take much time, however, it requires the patient to stay in the hospital.
Before proceeding with the surgical procedure, diagnostic tests should be performed. Among them - a general and biochemical analysis of blood, urine, and a coagulogram. If the cause of anuria (impaired urine outflow) is not clarified, instrumental examinations are required. These include excretory urography, ultrasound of the kidneys, computed tomography.
Nephrostomy technique
Patients naturally want to know what the nephrostomy is for, what it is and how it is installed. It should be noted that the removal of the drainage tube from the kidney to the skin surface for experienced surgeons is considered a simple operation. It is performed both under general anesthesia and with local anesthesia. Nephrostomy is carried out quickly, within 15-20 minutes. However, after the operation, the patient must be observed. This is necessary to assess the recovery of urine outflow. There are 3 options for conducting nephrostomy. Among them:
- Performing an open surgery.
- Laparoscopic drainage system.
- Percutaneous nephrostomy.
Most often, the last option is performed. Installation of a nephrostomy by puncture of the skin and underlying tissues is better tolerated by patients. In addition, percutaneous surgery is considered less traumatic compared to open surgery. It is performed under the supervision of ultrasound or radiography.
The technique of the operation includes a puncture of the skin, adipose tissue, muscles and renal parenchyma using a puncture needle. During nephrostomy, the doctor monitors the monitor. This is very important, since it is necessary to get into the pyelocaliceal system with accuracy without damaging the surrounding tissue. After the needle is inserted, a drainage tube is installed, the free side of which is connected to the urinal.
When is nephrostomy removed?
If the operation was carried out in order to perform medical procedures (chemotherapy, stenting of the vessels of the kidney), nephrostoma is removed after restoration of the physiological outflow of urine.
Sometimes the drainage tube is installed for an indefinite period. Most often with severe oncological diseases. At the same time, replacement of the nephrostomy is periodically required. It should be performed in the operating room. Unlike the initial surgical intervention, tissue puncture is not required, since a fistulous opening is formed.
Postoperative Recovery
Recovery after nephrostomy is fast. Already on the first day the patient can move around the room with a drainage tube. Take antibiotics after surgery should be for 5-7 days to prevent the infection process. Within 2-3 days, blood can enter the urinal. This is due to trauma to the vessels of the kidneys. After 3 days, bleeding stops. An ultrasound scan is performed to monitor urine outflow.
Nephrostoma: self-care at home
Since drainage is a foreign body for the body, its infection is possible at any time. This is warned to every patient who has a nephrostomy. Catheter care should be carried out continuously. The methods of preventing the infection include:
- Washing the drainage tube with saline and antiseptics. For this purpose, the drug "Chlorhexidine" or "Furacilin" is used.
- The application of a sterile dressing on the area of the postoperative wound.
- Timely emptying of the urinal.
- Medical supervision every 2 weeks.
Patients who have a nephrostomy can not exercise, lift weights. Bending the drainage tube can lead to complications, so the catheter should be in the same position.
Doctors reviews about nephrostomy
According to urologists, nephrostomy is a necessary measure that cannot be dispensed with. Despite the difficulties arising from the operation, and the need for constant care of the drainage, the installation of a catheter is necessary for patients to save them from fatal intoxication and infection.