Percutaneous Nephrostomy

An alternative to placing a ureteral stent is percutaneous nephrostomy (Biyani and Joyce 2002b). Dilatation of the urinary tract during pregnancy facilitates its placement. Denstedt preferred this procedure before the 22nd week of pregnancy (Denstedt and Razvi 1992). It can be done under local anesthesia, ultrasound localization, and in the three-quarter position (Kavoussi et al. 1992). It may result in discomfort of an external derivation, exposes the patient to the risks of stent displacement, cutaneous infection at the site of entry, and bacterial colonization following prolonged use of the stent (Biyani and Joyce 2002b; Kavoussi et al. 1992; Loughlin and Lindsey 2002; Zwergel et al. 1996). The risk of incrustation is identical to that of the ureteral stent, requiring that the stent be changed every 4-8 weeks (Kavoussi et al. 1992). In very septic patients, who rarely cannot tolerate intravenous sedation, percutaneous nephrostomy should be a good choice even if the three-quarter position is not always possible in such patients.

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