(A) Indications for surgery.
1, obstructive pyelonephritis, hydronephrosis or pus accumulation in the kidney, requiring drainage of the renal pelvis first.
2, percutaneous nephrolithotomy, first nephrostomy and then second stage stone extraction.
3.Pelvic ureteral junction (UPJ) stenosis, and nephrostomy is performed first when paracentesis is performed.
(B) Preoperative preparation.
1.Understand the function of both kidneys.
2.Exclude hematologic disease and bleeding tendency.
3. For patients with infection, give appropriate antibiotic treatment.
4. Perform B-type ultrasonography if available, and localize the anterior approach for surgery.
(C) Anesthesia.
Local anesthesia.
(iv) Position.
Supine position, with the affected side padded 25°~30°.
(V) Surgical steps.
The general puncture point is chosen below the twelfth rib margin, where it intersects with the posterior axillary line. The puncture angle is nearly 90° and enters the posterior renal calyces. The skin of the puncture point is cut with a sharp knife. With a two-part puncture needle, the puncture point is passed and punctured in the direction of preoperative B-mode ultrasound exploration or guided by a C-arm x-ray machine. The needle is passed through the lumbar dorsal muscle group to the perirenal membrane, at which point it feels slightly stiff and then enters the calyces to the renal pelvis, where urine is seen upon removal of the needle core.
A 0.038-inch diameter metal guidewire is passed into the kidney along the puncture needle tube, ideally pushing the metal guidewire into the ureteropelvic junction (UPJ) and into the ureter. If the metal guidewire fails to enter the ureter, it has to be placed into the suprarenal calyces or the renal pelvis and the metal guidewire is coiled up. The metal guidewire was withdrawn via the puncture needle, leaving the metal guidewire in place, using a set of fascial dilatation tubes. Along the metal guidewire, dilation is performed from the skin to the kidney, from F6 to F16, one after the other, step by step. When dilating, the skin incision is slightly enlarged, then one hand pulls the guidewire tightly, and the other hand pushes the dilating tube along the guidewire into the kidney area in the same direction as the puncture needle. For each number one dilatation tube pushed into the kidney, it is best to clarify its position under C-arm X-ray fluoroscopy and note whether the metal guidewire is twisted, angled, or dislodged.
The F16 dilatation tube with a rigid plastic sheath is pushed into the kidney along the guidewire, and then the assistant is instructed to fix the rigid plastic sheath. The operator fixes the metal guidewire with one hand and withdraws the dilatation tube with the other hand, at which time urine will be seen to flow out from the rigid plastic sheath. The front end of the F14 silicone catheter (or prostatic catheter or common catheter) is cut off and pushed into the kidney through the rigid plastic sheath along the guidewire. After clarifying the position of the guidewire in the kidney, the rigid plastic sheath is withdrawn first, followed by the guidewire. The catheter is secured at the skin with a silk thread and a urinary bag is attached. If an F16 dilated tube with a rigid plastic sheath is not available, a nephrostomy tube with F14 Meleco can be used and pushed into the kidney along the guidewire. After it is clear that it is in the correct position under X-ray surveillance, the metal guidewire is withdrawn and urine flow is seen.
After further clarification of the location by contrast, the fistula was fixed at the skin.
(vi) Postoperative management.
1.Observe whether the nephrostomy tube drainage fluid is clear, whether the urine color becomes clear, and record the daily urine volume.
2. Use antibacterial drugs to prevent and control infection.