LOOP NEPHROSTOMY ROBERT
H. HACKLER,
M.D.
From the Department of Urology, Medical College of Virginia and McGuire Veterans Administration Hospital, Richmond, Virginia
Loop nephrostomy has several advantages over straight nephrostomy, especially if long-term or permanent drainage is contemplated. Having control of both ends prevents nephrostomy displacement and/or total loss. Although not common, complications have occurred after U-tube innephrostomy. is3 These include hemorrhage, accurate tube placement, and arteriovenous fistula formation.
the past five years. This technique is patterned after that of Cabot and Holland.4 Tressidder’ used this method for the upper calyx but not for the lower calyx. Technique A Randall clamp of appropriate curve is negotiated through the upper calyx and capsule via a pyelotomy incision (Fig. 1). A 14 F red rubber catheter is then secured and brought into the renal pelvis. The same procedure is repeated through the lower calyx, and the two red rubber catheters are connected (Fig. 2). The upper catheter is then pulled through the kidney, and two silk sutures are placed at the level of the renal capsule (Fig. 3). A 24 F Silastic tube* (size 5/1s inch outer diameter and 3/1s inch inner diameter) is attached. The tip of the Silastic tubing should be sutured to the red rubber catheter in such a way that it will traverse the renal parenchyma without trauma. Silk sutures are tied on the Silastic tubing at the same level as previously mentioned on the red rubber catheter (Fig. 4). Three smooth eyelets are cut at different levels with a bone ronguer. The Silastic is then pulled through the kidney, and the two silk sutures determine the correct position of the eyelets (Fig. 5). MCV Station Richmond, Virginia 23298
FIGURES 1 to 5.
Technique. References
Under most circumstances, we prefer both ends of the Silastic tubing traversing renal parenchyma. Often there is prolonged urine leakage after one end of the tubing exits via the renal pelvis. Small diameter tubing may be necessary (depending on the amount of ureteral dilatation) when the ureter is used as one of the exit sites. We have had no complications after 24 loop nephrostomies performed on 16 patients during
582
1. Bissada NK, Cole AT, and Fried FA: Renal diversion with silicone circle catheters, Urology 2: 238 (1973). 2. Hawtrey CE, Boatman DL, Brown RG, and Schmidt JD: Clinical experience with loop nephrostomy for urinary diversion, J. Urol. 112: 36 (1974). 3. Comarr AE: Experience with the U-tube for renal drainage among patients with spinal cord injuries, ibid. 95: 741 (1966). 4. Cabot H, and Holland WW: Nephrostomy: indications and technique, Surg. Gynecol. Obstet. 54: 817 (1932). 5. Tressidder GC: Nephrostomy, Br. J. Ural. 29: 130 (1957). *Dow
UROLOGY
Corning
/
Corporation,
DECEMBER
1977
Midland,
/
Michigan.
VOLUME X, NUMBER 6
H. HACKLER,
M.D.
From the Department of Urology, Medical College of Virginia and McGuire Veterans Administration Hospital, Richmond, Virginia
Loop nephrostomy has several advantages over straight nephrostomy, especially if long-term or permanent drainage is contemplated. Having control of both ends prevents nephrostomy displacement and/or total loss. Although not common, complications have occurred after U-tube innephrostomy. is3 These include hemorrhage, accurate tube placement, and arteriovenous fistula formation.
the past five years. This technique is patterned after that of Cabot and Holland.4 Tressidder’ used this method for the upper calyx but not for the lower calyx. Technique A Randall clamp of appropriate curve is negotiated through the upper calyx and capsule via a pyelotomy incision (Fig. 1). A 14 F red rubber catheter is then secured and brought into the renal pelvis. The same procedure is repeated through the lower calyx, and the two red rubber catheters are connected (Fig. 2). The upper catheter is then pulled through the kidney, and two silk sutures are placed at the level of the renal capsule (Fig. 3). A 24 F Silastic tube* (size 5/1s inch outer diameter and 3/1s inch inner diameter) is attached. The tip of the Silastic tubing should be sutured to the red rubber catheter in such a way that it will traverse the renal parenchyma without trauma. Silk sutures are tied on the Silastic tubing at the same level as previously mentioned on the red rubber catheter (Fig. 4). Three smooth eyelets are cut at different levels with a bone ronguer. The Silastic is then pulled through the kidney, and the two silk sutures determine the correct position of the eyelets (Fig. 5). MCV Station Richmond, Virginia 23298
FIGURES 1 to 5.
Technique. References
Under most circumstances, we prefer both ends of the Silastic tubing traversing renal parenchyma. Often there is prolonged urine leakage after one end of the tubing exits via the renal pelvis. Small diameter tubing may be necessary (depending on the amount of ureteral dilatation) when the ureter is used as one of the exit sites. We have had no complications after 24 loop nephrostomies performed on 16 patients during
582
1. Bissada NK, Cole AT, and Fried FA: Renal diversion with silicone circle catheters, Urology 2: 238 (1973). 2. Hawtrey CE, Boatman DL, Brown RG, and Schmidt JD: Clinical experience with loop nephrostomy for urinary diversion, J. Urol. 112: 36 (1974). 3. Comarr AE: Experience with the U-tube for renal drainage among patients with spinal cord injuries, ibid. 95: 741 (1966). 4. Cabot H, and Holland WW: Nephrostomy: indications and technique, Surg. Gynecol. Obstet. 54: 817 (1932). 5. Tressidder GC: Nephrostomy, Br. J. Ural. 29: 130 (1957). *Dow
UROLOGY
Corning
/
Corporation,
DECEMBER
1977
Midland,
/
Michigan.
VOLUME X, NUMBER 6
