Drainage of the renal pelvis under enhanced X-ray

The article is professionally consulted by MSc, BS. Dang Manh Cuong - Doctor of Radiology - Department of Diagnostic Imaging - Vinmec Central Park International General Hospital.

Obstruction of the urinary tract is a condition in which urine cannot flow normally on one or both sides of the ureter. Urine that flows from the kidneys to the bladder flows back to the kidneys and carries a risk of increased pyelonephritis, renal failure, and superinfection.

Obstruction of the urinary tract can have many different causes, but all lead to a common consequence: increased renal pressure, damage to one or both kidneys. With the goal of re-establishing the urinary tract, percutaneous pyelonephritis is the method of placing a catheter that drains the renal pelvis downstream through the entrance at the lumbar fossa. This is a technique with high safety, being widely applied in clinical practice, bringing immediate effect in the treatment of benign or malignant urinary tract obstruction.
Indications
Obstruction of the excretory tract due to many causes: Kidney stones, tumors of the renal pelvis, ureters, retroperitoneal tumors, compression of the pelvis, invasion of the ureters or bleeding due to cystitis. Injury to the ureter: Due to trauma, ureteral stricture after surgery, or retroperitoneal fibrosis. Perform diagnostic tests for urological pathology: pyelonephritis downstream, evaluate the differential pressure of the bladder, ureters, biopsy the epithelium of the ureter. Urinary tract pathology intervention: urethral fistula (benign or malignant), percutaneous stone removal; dilatation - placement of ureteral stents. When endoscopic retrograde cholangiopancreatography fails. Contraindications:
Severe coagulopathy: INR value >1.5; platelet count <50G/l requires platelet transfusion before intervention; Prothrombin <50% need fresh plasma transfusion before intervention People with severe electrolyte disorders (serum potassium index >7 mEq/l), need treatment to bring blood potassium index to normal limit before intervention . Uncontrolled hypertension (systolic blood pressure >180mHg) People who are allergic to iodine contrast agents. People whose organs (liver, spleen, colon...) are located behind the kidney.

To perform pyelonephritis drainage under enhanced X-ray, it is necessary to prepare:
Implementation team:
Specialist doctor, auxiliary doctor; Electro-optical technician; Nursing; Anesthesiologist/technologist (if patient is difficult to cooperate). Means of use:
Fluoroscopy; Film, film printers and image storage systems.; Lead vest, apron to help shield from X-rays.; Flat and curved transducer ultrasound machine; Sterile nylon bag to wrap the ultrasound transducer. Drugs:
Local anesthetics; General anesthetics ; Water-soluble iodinated contrast agent; The solution helps to disinfect the skin and mucous membranes. Common medical supplies:
5.10ml syringe; Aseptic intervention kit (scissors, tongs, knife, tool tray, etc.); Distilled water (physiological saline); Surgical clothing; Cotton gauze, surgical medical adhesive tape; Medicine box and accident first aid box. Special medical supplies:
Kim Chiba and corresponding conductors; 4-5F angiography catheter; Standard lead 0.035'' corresponds to angiographic catheter Tube for renal pelvis drainage; Drug pump connection line; Suture to fix the catheter. Patients need to prepare:
Be explained in detail about the procedure to coordinate with the doctor. Perform clinical examination before the procedure. Fasting, drinking before 6 hours. Do not drink more than 50ml of water. In the intervention room, the patient is placed in the supine or prone position, depending on the drainage position. The doctor installs a machine to monitor breathing, pulse, electrocardiogram, blood pressure, and oxygen saturation in the peripheral blood. Disinfect the skin and cover with a sterile, perforated cover. In case the patient is too excited, unable to lie still, sedation will be prescribed.

Steps to perform pyelonephritis drainage under enhanced X-ray:
Step 1: Enter the renal pelvis
Make an incision in the skin and subcutaneous tissue behind the peritoneum (lumbar fossa). Under ultrasound guidance and enhanced fluorescence, percutaneous pyelonephritis was performed with a 21G needle. Determine the position of the needle tip in the renal pelvis with contrast. Step 2: Make a tunnel into the renal pelvis through the skin
Through the 21G needle, insert the 0.018 inch lead into the renal pelvis then replace the 21G needle with 6F. Replace the 0.018inch lead with a 0.035 J-tipped lead and insert the catheter into the renal pelvis and perform a pyelogram, downstream of the ureter. Tunneling through 0.035 J-tipped conductors with sockets. Step 3: Place the pyelonephritis
Insert the catheter into the renal pelvis through the 0.035 J-tipped wire. Locate the tip of the drain with contrast. Fix the drainage tube in the renal pelvis and outside the skin. Step 4: Evaluation of results
The procedure is considered successful when the tip of the drainage tube is placed in the renal pelvis, the renal pelvis collapses and urine flows out the drain. No escape of contrast agent into the abdomen or retroperitoneal space was observed.

Infection:
Infection of the draining foot: cleaning, dressing change and local disinfection. Urinary tract infections: systemic antibiotics are indicated. Sepsis: conduct specialist consultation. Bleeding in the renal pelvis, ureter, retroperitoneum:
Evaluation of the quality of urine excreted through the drain and drain. Use your hands to press at the lumbar hole with a drain for 15-20 minutes. If bleeding persists, move to intervention room to replace with another larger size drain. After replacing the drain tube, if bleeding is still done, perform vascular intervention. Vinmec International General Hospital with a system of modern facilities, medical equipment and a team of experts and doctors with many years of experience in medical examination and treatment, patients can rest assured to visit. and hospital treatment.
Before taking a job at Vinmec Central Park International Hospital from December 2017, Doctor Dang Manh Cuong has over 18 years of experience in the field of ultrasound - diagnostic imaging in Transport Hospitals. Hai Phong, MRI Department of Nguyen Tri Phuong Hospital and Diagnostic Imaging Department of Becamex International Hospital.
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