Percutaneous renal calyces drainage

Percutaneous pyelonephritis is to establish a path to drain urine from the renal pelvis to the outside through the skin to resolve water retention in the renal pelvis, pus pus in the renal pelvis to avoid local infection, and limit the possibility of infection. spread more widely.
Percutaneous pyelonephritis is only a temporary measure to solve acute cases, and prolongs the time to help improve the patient's condition to facilitate the resolution of the causes of obstruction. congestion.

2.1 Indications Kidney stones, ureteral stones or sclerosing cystitis of the ureter, Pyelonephritis, post-operative ureteral stricture, Malignancy: uterine cancer, cancer of the urinary system, prostate, or metastatic pelvic cancer,... In pregnancy, there is an obstruction of the excretory tract and the cause of the obstruction cannot be completely resolved. 2.2 Contraindication Severe coagulopathy, unresponsive to treatment Undergoing treatment with anticoagulants such as: heparin Renal tumor, renal tuberculosis Severe systemic disease with fatal prognosis

3.1 Preparation Before percutaneous pyelonephritis, the patient needs to do basic tests, basic coagulation. In addition, ultrasonography of the urinary tract is needed, and radiographs of the urinary system may be performed in cases of urinary tract stones.
For patients with signs of infection, pus-filled kidneys must be given antibiotics before the procedure, and signed a written consent to do percutaneous pyelonephritis.
3.2 Procedure steps Checking the record: Checking the tests done Checking the patient: Matching name, age and diagnosis The patient is tested for response to lidocaine anesthetic The patient is examined pulse, blood pressure before the procedure The patient is lying on the side to expose the side of the body to be drained The doctor needs to wash his hands, wear sterile gloves 35 Disinfect the skin to be drained and a sterile, perforated dressing Locate by ultrasound to find the point of drainage into the renal pelvis Anesthetize the drainage area Insert a specialized catheter into the renal pelvis guided by ultrasound. Use a 20ml pump to drain the fluid in the renal pelvis. Take samples for testing: biochemical, cell, culture to identify bacteria, PCR TB. Insert the catheter into the renal pelvis, withdraw the catheter, and insert the tube into the renal pelvis. When the drain tube is in place in the renal pelvis, proceed to connect the drain tube to the infusion set and the urine bag. Stitch to fix drainage tube. Then ultrasound to check the position of catheter drainage in the renal pelvis. Bandage the leg area to save.

3.3 Monitoring and managing complications After the procedure, the patient should be monitored for vital signs including: pulse, temperature, blood pressure and breathing rate. Use pain relievers and antibiotics as ordered if the patient is in pain. In addition, it is necessary to monitor fluid properties such as quantity and color through the drainage tube. After 24 hours, it is necessary to repeat ultrasound of the urinary kidneys.
Some complications may occur after drainage such as:
Bleeding: Monitor the color of urine flowing through the renal drain, if bleeding is less then medical treatment. If medical treatment is unsuccessful, angiography should be performed to determine the source of bleeding and embolism. Bleeding may be from the intercostal vessels or from the parenchyma. In case of severe bleeding from the branches of the renal artery, blood transfusion is needed to stabilize the patient.. Infection: use antibiotics to prevent infection Injury to nearby organs is rare eg. such as: colon, in most cases treated conservatively with antibiotics and fasting. Perirenal abscess due to urine leakage: first medical treatment with antibiotics, anti-inflammatory. If medical treatment is not effective, surgical cleaning of the perirenal cavity must be performed. To register for examination and treatment at Vinmec International General Hospital, you can contact Vinmec Health System nationwide, or register for an online examination HERE
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