Needle nephrostomy, percutaneous

When urgent decompression is needed, the treatment of choice is percutaneous needle nephrostomy under local anesthesia. However, if cystoscopy is being planned and the situation is not urgent, it may be best to insert a retrograde JJ stent at the time of cystoscopy. 

WiCKBOM was the first to describe percutaneous diagnostic antegrade pyelography in 1954. Percutaneous needle nephrostomy to relieve obstruction was subsequently described by Goodwin et al. (1955). Stables et al. (1978) later demonstrated the very low complication rate of this procedure and established it as the treatment of choice for the emergency relief of renal obstruction. 

Goodwin WE, Casey WC, Woolf W (1955) Percutaneous trocar (needle) nephrostomy in hydronephrosis. JAMA 157 891-894... 

In patients with renal transplants, the approach to percutaneous nephrostomy depends upon the surgical anatomy. Most transplants are extraperito-neal and located in the iliac fossa. Thus, the renal pelvis usually faces posteromedially. As a result, an anterolateral approach is usually best to avoid passage through the peritoneal cavity. In most cases, real time ultrasound is used to guide needle puncture. With intraperitoneal renal transplants, CT guidance may he necessary to avoid inadvertent injury to the howel (Hunter et al. 1983). 

Major complications resulting from insertion of a percutaneous nephrostomy are unusual in children. Initially, percutaneous nephrostomy was considered less applicable to the pediatric population because of the need for general anesthetic. However, improvements in sedation techniques, monitoring equipment, catheters, and the widespread use of ultrasound for needle puncture guidance has helped percutaneous nephrostomy become a safe and effective procedure in the pediatric population (Ball et al. 1986 Pfister et al. 1981 Stanley 1986). 

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