NEPHROSTOMY, PERCUTANEOUS

General Information

DEFINITION--Cutting into the kidney, usually over a collecting system inside the kidney where a large kidney stone has formed. May also create an opening into the kidney to maintain temporary or permanent urinary drainage.

BODY PARTS INVOLVED--Kidney; ureter.

REASONS FOR SURGERY--To create an opening into the kidney to maintain temporary or permanent urinary drainage.

SURGICAL RISK INCREASES WITH

• Adults over 60.
• Obesity; smoking; alcoholism.
• Newborns and infants.
• Poor nutrition.
• Recent or chronic illness.
• Use of drugs such as: antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; beta-adrenergic blockers; or cortisone.

What To Expect

WHO OPERATES--General surgeon or urologist.

WHERE PERFORMED--Hospital.

DIAGNOSTIC TESTS

• Before surgery: Blood and urine studies; sonogram or CT scan (See Glossary).
• After surgery: Blood and urine studies.

ANESTHESIA--General anesthesia by injection and inhalation with an airway tube placed in the windpipe or local anesthesia in some cases.

DESCRIPTION OF OPERATION

• An incision is made, usually in the left or right flank, but sometimes in the abdomen.
• A blunt, curved clamp is passed into the kidney.
• The tip of a catheter is drawn into the kidney and brought out through a separate stab incision in the flank.
• Stone removal may be accomplished with this procedure, or by pulverization by means of ultrasonic, electro-hydraulic or laser probes passed through the tract.
• Urine produced by this kidney reaches the outside through the catheter.

POSSIBLE COMPLICATIONS

• Excessive bleeding.
• Surgical-wound infection.
• Inadvertent injury to the vena cava or other organs near the kidney.

AVERAGE HOSPITAL STAY--5 to 7 days.

PROBABLE OUTCOME--Expect complete healing without complications. Allow about 4 weeks for recovery from surgery.

Postoperative Care

† Move and elevate legs often while resting in bed to decrease the likelihood of deep--vein blood clots.

MEDICATION---

Your doctor may prescribe:

• Pain relievers. Don't take prescription pain medication longer than 4 to 7 days. Use only as much as you need. > Stool softeners to prevent constipation. > Antibiotics to fight infection. > Avoid aspirin.

ACTIVITY

• Resuming daily activities, including work, as soon as you are able can help the healing process.
• Avoid vigorous exercise for 6 weeks after surgery.
• Resume driving 2 to 3 weeks after returning home.
• Resume sexual relations when your doctor determines that healing is complete.

† Clear liquid diet until the gastrointestinal tract begins to function again. Then eat a well--

balanced diet to promote healing.

• Vitamin and mineral supplements (sometimes).

Call Your Doctor If

† Pain, swelling, redness, drainage or bleeding increases in the surgical area.

• You develop signs of infection: headache, muscle aches, dizziness or a general ill feeling and fever.
• You experience nausea, vomiting, constipation or abdominal swelling.