Wednesday, October 3, 2012

Percutaneous Nephrostomy (Indications+ Relative Contraindications)


Indications
1. Urinary tract obstruction
(a) Malignancy (commonly cervical, prostatic, metastatic pelvic adenopathy, urothelial)
(b) Stone
(c) Ureteric or anastomotic stricture
(d) Pyonephrosis
(e) Assessment of functional recovery of obstructed kidney
2. Urinary diversion
(a) Ureteral injury
(b) Vesical fistula
(c) Hemorrhagic cystitis
3. Access for subsequent interventional or endoscopic procedures
(a) Removal of renal or ureteral calculi
(b) Antegrade ureteral stenting
(c) Dilatation of ureteral or anastomotic stricture
(d) Endopyelotomy
(e) Deliver medications (fungal ball, urothelial tumors, stone dissolution)
(f) Ureteral occlusion for refractory leak
(g) Biopsy of urothelial lesion
(h) Foreign body retrieval

Relative Contraindications
1. Uncontrolled coagulopathy
(a) INR > 1.3
(b) aPTT > 1.5 times normal
(c) Platelet count < 50–100 × 109/L
2. Anticoagulant therapy (aspirin, heparin, warfarin)
3. Uncontrolled hypertension
4. Terminal illness, imminent death

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