Nephrostomy tube salvage

Case contributed by Dr Ian Bickle

Presentation

Left nephrostomy tube inserted 3 days previously. Initially good output with clear urine. Past 12 hours 40mls of blood stained urine.

Patient Data

Age: 60
Gender: Male
Fluoroscopy

Different patient - same problem. Tube migration is common.

Tube migration is common - hanging on for dear life in a calyx, half way out or completely out, one may be able to salvage the nephrostomy, without the invasiveness of starting the procedure afresh. 

Case Discussion

It is fairly common for percutaneous nephrostomy tubes to become mal-positioned.  The tube may frankly fall out completely or be displaced to variable degrees.

Urine output may be decreased or absent.  Urine may become blood-stained due to the pigtail of the catheter traumatizing the urothelium.

Prompt notice to medical attention will usually allow nephrostomy salvage or the existing tube or re-insertion along the established, rather than the alternative of a complete new insertion, which is more invasive.

Typically the tube can be re-positioned with the use of a 038 'worker' wire through the existing tube. On occasion a hydrophilic wire may be needed to re-enter the pelvico-calyceal system.

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Case information

rID: 21873
Case created: 23rd Feb 2013
Last edited: 24th Jan 2016
Inclusion in quiz mode: Included

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