Nephrostomy: Review and Presentation of a New Technique

Abstract

ALBARRAN in 1896 was the first to use the term nephrostomy for the surgical incision of a kidne) to provide temporary or permanent drainage. In the intervening years since then, numerous techniques of establishing drainage have been introduced. Ideally, the method should be technically easy to perform by most surgeons, require minimal mobilisation of the kidney or its surrounding structures ; cause little trauma to the renal parenchyma and pelvis ; achieve accurate placement of the nephrostomy catheter so as to provide the best possible drainage; utilise instruments and catheters commonly available in most hospitals ; and allow the catheter to be easily replaced in the post-operative period. REVIEW OF METHODSNephrostomy without Pye1otomy.-In the original procedure described by Albarran (Albarran, 1896; Papin, 1928), a tube was placed through the nephrotomy wound into the renal pelvis. sutured in place and led out through the wound. If feasible, the edges of the nephrotomy wound were sutured to the skin, marsupialising the calyces.Marion described his method of permanent nephrostomy drainage in 1919. A long speculum (rlilatateur de Tripier) was introduced through a lateral cortical incision into the renal pelvis. The catheter was then inserted through the speculum and the speculum withdrawn while the catheter was left in place.Crosbie, in 1925, made an incision in the renal capsule and then passed a closed half-length clamp through the parenchyma to the renal pelvis. Afterwards, the tract was widened with a finger so that a & in. rubber tube could be passed to the renal pelvis. Rolnick (1938) described a similar technique. He inserted an I8 or 20 French mushroom catheter with a forceps, removed the forceps and left the catheter in place. Hxmostasis was obtained by packing between the renal parenchyma and the catheter.Trocar nephrostomy was introduced in I949 by Schinagel. A longitudinal muscle-splitting incision was made parallel to the sacrospinalis muscle and below the tweIfth rib. The lower pole of the kidney was steadied with the right index and middle fingers and a small incision was made in the renal capsule. The trocar was thrust through the parenchyma of the kidney into the renal pelvis ; the catheter inserted through the lumen of the trocar and the trocar removed.In 1957, Thompson and Hooks described an ingenious method of percutaneous nephrostomy that was especially useful i n instances where nephrostomy drainage had previously been carried out and re-institution of such drainage became necessary at a later date. They first inserted a long spinal needle from which the hub had been removed. A Kreutzmann trocar was threaded over the spinal needle and inserted into the kidney. A filiform was placed through the trocar and the trocar was removed. After dilating the tract to 22 French with woven followers. a Council1 catheter was placed with its tip in the renal pelvis. The final position was checked with an injection of radiographic medium. Nephrostomy with 1Pyelotsmy.-As early as 1920, Toupet condemned nephr...