Presentation
Early middle aged patient with know PUJ stone, presents right flank pain and sepsis.
Patient Data
Early US revealed a Rt hydronephrosis
Large right PUJ stone.
Mild hydronephrosis, with lower pole calyces essentially normal, with not clubbing of the calyces.
This and a high sited kidney in an obese patient meant mid-pole pucture required, however steep cranial angulation, makes drain insertion more challenging.
8F nephrostomy inserted.
'Dirty' urine ascertained.
Case Discussion
Percutaneous nephrostomy inserted can be 'life saving' in the context of sepsis.
It is essentially synonymous with abscess drainage, with the obstruction - typically a stone - causes stasis and then infection.
Usually the degree of hydronephrosis is moderate to severe making puncture uncomplicated, but on occasion a less dilated system requires puncture - this is best done with a 'micropucture set'.
Other factors which make nephrostomy insertion difficult include:
- poorly cooperative patient
- patient with difficulties ascertaining good pain control
- high BMI
- immobility preventing ideal positioning (prone)
- high sited kidney
- mid pole or upper pole punctures
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