E. Percutaneous nephrostomy – Explanation
Percutaneous nephrostomy would be the best intervention to temporarily decompress
the renal collecting system.
ESWL becomes extremely less effective once the stone goes upto 2-3 mm in size.
Less than 50% chance of success. This patient has AKI, a very large stone which is
clearly obstructive uropathy, and therefore urgent percutaneous nephrostomy is
indicated.
PERCUTANEOUS NEPHROSTOMY
This is used as a temporary relief of ureteric obstruction where ureteric stones fail to
respond to analgesics and where renal function is impaired due to the stone. It is an
intervention that decompresses the renal collecting system by placing a catheter,
through the skin, into the kidney, under local anaesthetic. This catheter allows the urine
to drain from the kidney into a collecting bag, outside the body. Another method that is
often used to relieve ureteric obstruction is an insertion of a JJ stent.
The function of a percutaneous nephrostomy is to bypass the ureteric obstruction and
therefore relieve the pain associated with the obstruction.
The percutaneous nephrostomy tube can restore efficient peristalsis to the ureteric wall
and in some cases this allows the stone to pass down and out of the ureter with the
nephrostomy in situ, however in many instances, it simply sits where it is and
subsequent definitive management to remove the stone is still required.
