One major function of the kidney is to filter blood and produce urine. Urine flows from the kidneys to the urinary bladder via a small tube called the ureter. Sometimes the normal flow of urine becomes obstructed due to stones, congenital abnormalities, abdominal and pelvis masses, or trauma. This obstruction to the flow of urine can lead to infection and loss of kidney function.
By utilizing a multidisciplinary approach in conjunction with experts in Interventional Radiology, Urology and Nephrology at Children's National Hospital, we formulate a treatment plan to preserve kidney function. This plan may require percutaneous nephrostomy tube placement, a small tube placed through the skin of the lower back into the kidney under ultrasound and fluoroscopic guidance. Urine will then drain into a small bag external to the patient. A nephrostomy tube may be in place for days, weeks or months. The decision to remove the nephrostomy tube is also made after consulting with these teams.
In some patients, external drainage of urine (via a nephrostomy tube) may not be the best option. Using the same approach as for a nephrostomy tube mentioned above, the site of obstruction to urine flow can be traversed and a small tube (stent) placed across this narrowed segment to keep it open. This allows for urine to flow in the normal physiologic way. There are two types of tubes which can be placed to achieve this: internal or external. An internal ureteral stent is completely inside the body with one end inside the central part of the kidney where urine is produced and continues down the ureter into the urinary bladder where it ends. In contrast, an external stent is similar to an internal stent but with an additional component which extends from the central part of the kidney out through the patient’s back. Experts at Children’s National can place both types of stent from a percutaneous approach using ultrasound and X-ray guidance.
In cases where obstruction to urine flow is distal to the urinary bladder then a tube inserted directly into the urinary bladder (cystostomy tube) may be required to allow for urine flow. A small tube is placed under ultrasound and fluoroscopic guidance from the lower abdomen into the urinary bladder. The tube is attached to an external bag to allow for external urinary drainage.
Using ultrasound, the interventional radiologist will locate the kidney and insert a special hollow needle through the skin into the kidney. Using live X-ray (fluoroscopy) for guidance, the doctor will guide a small catheter into the kidney. The portion of the catheter on the outside of the skin will be connected to a drainage bag. A small stitch (suture) and/or an adhesive dressing will hold the catheter in place on the surface of the skin.
No. This procedure is performed under general anesthesia, so your child isn't awake.
Approximately one hour.
Your child will not feel pain during the procedure, but some patients may feel minor discomfort around the catheter insertion site for a few days following the procedure.
The procedure is considered low risk. However, potential complications include:
Nurses will monitor your child while awaking from sedation medications in the recovery area for a couple hours and monitor for immediate complications. Your doctor may decide to have your child admitted to the hospital for an overnight stay.
As mentioned, there may be some discomfort around the catheter insertion site for some days following the procedure, which is easily relieved by over-the-counter medications.
Do not remove the bandage and keep it clean and dry at all times. Please contact the Interventional Radiology department if the bandage is becoming loose or falls off. The bandage should be changed once a week and an appointment should be made to have this done unless a family member has been trained in changing the bandage.
The experts in the Interventional Radiology Program will place gauze and a clear bandage over the catheter site. In addition, the catheter will be secured with a locking device (StatLock®), which must not be removed. The bandage must remain dry and in place at all times. You may sponge-bathe your child, but keep the site dry.
Removing the nephrostomy tube is a simple procedure. First, stitches are cut from the skin and the catheter is pulled out from the body. Pressure is applied to the insertion site during removal and for a few minutes after to minimize any bleeding that may occur. We will place a bandage that you can remove after 48 hours. All tubes remain in place for a time period determined by the managing physician but typically until the underlying problem has been treated properly.
Your child must avoid activities, such as contact sports or rough playing, which may result in a pull to the catheter and damage to or loss of the catheter.
Our pediatric interventional radiologists perform a full range of minimally invasive, image-guided procedures to both diagnose and treat disease in infants, children and adolescents. Discover more about the treatment we offer.
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Children’s National interventional radiologists perform a full range of minimally invasive, image-guided procedures to both diagnose and treat disease in infants, children, and adolescents.