Nephrostome: what is it, operation, care, prevention and consequences

Kidneys are needed in order to provide one of the most important functions - the separation of metabolic products from the body. If this is not done, a person can die from intoxication with his own metabolites.

In some cases, kidney function is difficult due to various pathological conditions. Among them - oncological formations, urolithiasis. At the same time, blood filtration and absorption of useful elements occurs, but the end products are not output. And to establish this process, the nephrostomy is established.

What is it and in what cases is it necessary? The nephrostome is a tube (drainage) connected to the kidney of the kidney and pulled outward. It is needed to ensure the outflow of urine and prevent intoxication of the body.

Nephrostome - what is it? Functions

As is known, in the case of cancer, a radical operation and at the same time preserve the functions of the body is not always obtained. Sometimes the affected tissue is removed completely to avoid the spread of cancer. In other cases, on the contrary, a radical operation is impossible because of pronounced disturbances in the functioning of the organism. For this purpose, palliative surgical interventions were invented. They do not lead to a cure, but they contribute to the restoration of the physiological capabilities of the organism. Palliative surgery is performed in all areas of oncology, with no exception and urological help.

So, to establish the excretory function of the body and save a person from endogenous intoxication, perform nephrostomy. It consists in placing the drainage tube in the cup-and-pelvis system of the kidney. The free end of the nephrostomy is drawn outward, that is, to the surface of the skin. A special container is connected to it, and the outflow of final products of metabolism is carried out, bypassing the bladder, ducts and urethra.

This operation relates 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 her, he will explain to the patient before the surgical intervention. And the installation of renal drainage is performed only with the written consent of the patient or his loved ones. It is necessary to assess the general condition of the patient and find out whether it is possible to conduct such an operation.

Indications for delivery of nephrostomy

Like any artificially created drainage, nephrostomy in the kidney performs a vital function. Most often it is prescribed for oncological diseases of the genitourinary system. Less often - with other serious urological pathologies. There are special indications, according to which the nephrostomy is established. The operation is performed if the following indications are available for nephrostomy:

1. Cancer of the kidney or other organs of the urinary system.
2. Hydronephrosis.
3. Urolithiasis with predominance of large concrements.
4. Metastases of the tumor of any localization, squeezing the organs of the small pelvis.
5. Obstruction of the ureter due to compression of it 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, it is possible to avoid chronic and acute kidney failure.

Such an operation does not always mean that artificial drainage will remain in the body all the time. In some cases, after special treatment (surgical intervention, chemotherapy), the nephrostomy is removed. Sometimes the restoration of urine outflow is necessary for the time of performing diagnostic manipulations (stenting).

Contraindications to nephrostomy

Despite the urgent need for surgery, nephrostomy can not always be performed. Contraindications include the following conditions:

• Impaired blood clotting;
• Uncontrolled arterial hypertension;
• Reception of anticoagulants.

To diseases in which blood clotting is disturbed, include hemophilia, hemorrhagic vasculitis, thrombocytopenic purpura, etc. In these pathologies, any surgical interventions are life threatening. The same applies to taking anticoagulants - medications that dilute blood. Nephrostomy is not installed and at high arterial pressure, which does not lend itself to medical correction. To conduct a surgical intervention in a similar condition is contraindicated, because of the risk of developing a stroke and cardiogenic shock.

Preparation for nephrostomy

In cases of violation of the outflow of urine, which can not be eliminated with the help of medications, you need a kidney nephrostomy. The operation for its installation, as a rule, does not take much time, but requires the patient's stay in the hospital.

Before proceeding to the surgical procedure, diagnostic tests should be performed. Among them - a general and biochemical blood test, urine, coagulogram. If the cause of anuria (a violation of the outflow of urine) is not clear, instrumental examinations are required. These include excretory urography, renal ultrasound , computed tomography.

Technique for nephrostomy

Patients naturally want to know what the nephrostome 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 surface of the skin for experienced surgeons is considered a simple operation. It is performed both under general anesthesia and with local anesthesia. Nephrostomy is carried out quickly, for 15-20 minutes. However, after performing the operation, the patient should be observed. This is necessary to assess the recovery of urine outflow. There are 3 options for nephrostomy. Among them:

1. Perform an open surgical operation.
2. Laparoscopic drainage installation.
3. Percutaneous nephrostomy.

Most often the last option is executed. Installation nephrostomy by puncturing the skin and underlying tissues is better tolerated by patients. In addition, percutaneous surgery is considered less traumatic, compared to open surgical intervention. It is performed under the supervision of ultrasound or radiography.

The technique of the operation involves puncturing the skin, fat, muscle and renal parenchyma with a puncture needle. During the nephrostomy, the doctor watches the monitor. This is very important, since it is necessary to accurately get into the cup-and-pelvis system, without damaging the surrounding tissues. After the introduction of the needle, a drainage tube is installed, the free side of which joins the urine receiver.

When are nephrostomy removed?

If the operation was performed for the purpose of performing therapeutic procedures (chemotherapy, stenting of the kidney vessels), the nephrostomy is removed after restoration of the physiological outflow of urine.

Sometimes the drainage pipe is installed for an indefinite period. Most often with cancer of a severe degree. Periodically, nephrostomy replacement is required. It must be performed under operating conditions. Unlike the initial surgery, a puncture is not required, since a fistulous opening is formed.

Recovery after surgery

Recovery after nephrostomy occurs quickly. Already in the first day the patient can move around the room with a drainage tube. Take antibiotics after the operation should be for 5-7 days to prevent infection. Within 2-3 days, blood can enter the urine collection. This is due to traumatization of the kidney vessels. After 3 days, the bleeding stops. For monitoring the outflow of urine, ultrasound is performed.

Nephrostome: home care yourself

Since drainage is a foreign body to the body, infection can occur at any time. This is warned of every patient who has a nephrostomy. Care of the catheter should be carried out constantly. Methods of preventing the infection process include:

1. Washing of the drainage tube with physiological solution and antiseptics. To this end, the drug "Chlorhexidine" or "Furacilin" is used.
2. Apply a sterile bandage to the area of the postoperative wound.
3. Timely emptying the urinal.
4. Control of the doctor every 2 weeks.

Patients who have a nephrostomy, can not exercise, lift weights. The kink of the drainage tube can lead to complications, so the catheter should be in the same position.

Reviews of doctors about nephrostomy

According to urologists, nephrostomy is a forced measure, without which one can not do without. Despite the difficulties arising from the operation, and the need for constant care for drainage, the installation of the catheter is necessary for patients to save them from deadly intoxication and infection.