Nephrostomy tract dilatation

Percutaneous treatment of diseases affecting the urinary tract most often begins with accessing a collecting system and placing a nephrostomy tube. Thus, nephrostomy insertion is the basic technique upon which percutaneous surgical procedures are built. This chapter discusses nephrostomy tube insertion, ureteral stent insertion, ureteral stricture dilatation, nephrostomy tract dilatation, percutaneous removal of calculi, endopyelotomy techniques used in the treatment of UPJ strictures and percutaneous renal angioplasty for treatment of renovascular hypertension. 

Nephrostomy tract dilatation is a procedure that translates a simple drainage entry procedure into percutaneous surgery and r allows the introduction of stents or other devices. 

Endurology is minimally invasive therapy involving the urinary tract. It is the natural evolution of techniques developed for treatment of renal obstruction using percutaneous access. Access to the collecting system is via a puncture identical to that used in placement of percutaneous nephrostomy. Sequential dilatation of the track allows for placement of an introducer sheath that allows for the endosurgical treatment of a variety of conditions. Endourologic procedures include ureteral dilatation, ureteral stenting, calculus removal (percutaneous nephrolithotomy), and endopyelotomy (percutaneous pyelo-plasty). 

The sheath is then removed and the tract is dilated using an 8-F fascial dilator. The ideal nephrostomy catheter is an 8-F self-retaining pigtail with adequate side holes (Flexima, Boston Scientific, Watertown, Mass.). 

After dilatation an Amplatz sheath is inserted over the last dilator. The dilators are then removed leaving only the Amplatz sheath and a guidewire in position. Once the tumor is visualized biopsies are taken both of the tumor and of the apparently normal renal pelvis. The tumor is then resected with diathermy. Tamponade of the tract is maintained with a 30-F nephrostomy catheter. The following day brachytherapy is given to the track to ensure that track tumor implantation does not occur (WooDHOUSE et al. 1986). It is stressed that this treatment is used only for low grade TCC or as... 

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