What is Nephrostomy Surgery?
Nephrostomy is a procedure in which a catheter (plastic tube) is inserted through the skin and into the kidney to drain it of urine. Urine drains into a bag outside the body.
Who is an ideal candidate for Nephrostomy Surgery?
If patient have a stone in ureter that is large and / or of abnormal shape like stag horn calculus in the renal pelvis which either needs to be dissolved chemically or by Intracorporeal Shortwave Lithotripsy -ICSWL, if patient has a stricture in ureter that hampers the passage of the stone thus causing complete blockage and back pressure on the kidney, if there is a retroperitoneal tumour that is pressing on the renal pelvis or ureter causing ureter to kink, if patient have a tumour of the renal pelvis that has been resected and needs local chemotherapy, then patient is an ideal candidate for Nephrostomy.
Preparation before Nephrostomy Surgery:
Either the day before or on the day of the nephrostomy, blood samples will be taken. Other diagnostic tests done before the procedure vary depending on why the nephrostomy is being done, but the patient may have a computed tomography (CT) scan or ultrasound to help the doctor locate the blockage.
Patients should not eat for eight hours before a nephrostomy. On the day of the procedure, the patient will have an intravenous (IV) line placed in a vein in the arm. Through this the patient will receive antibiotics to prevent infection, medication for pain, and fluids. The IV line will remain in place after the procedure for at least several hours, and often longer.
What does the procedure of Nephrostomy Surgery involve?
The entire procedure may take about an hour. Nephrostomy is performed in the operating theatre under stringent sterile conditions. Nephrostomy will be performed under local anesthesia and sedation to relieve anxiety, pain and discomfort during the procedure. Patient will lie flat on his stomach on the operating table. Nephrostomy procedures involve insertion of a catheter (small tube) through the skin into the kidney to drain urine. These procedures can relieve urinary obstruction, divert urine and provide access for opening of clogged or narrowed structures within the kidney, bladder and urinary tract. In circumstances of ureteral narrowing (stricture) or tear of the ureter; placement of a ureteral stent (flexible tube) during nephrostomy can open a clogged ureter or bypass damaged structures allowing urine to drain.Nephrostomy and ureteral stent may be necessary for patients whose normal urine drainage is compromised or occluded by renal stones, mass, edema (possibly post-surgical swelling), scarring, trauma or malignant encasement of the ureter. Nephrostomy and ureteral stent procedures are performed on adults under conscious / IV sedation. General anesthesia is necessary to complete these procedures on newborns and small children. For nephrostomy, the patient is usually positioned in a stomach or side lying position. The radiologist uses ultrasound guidance to locate the kidney and determine the site of entry (usually below the ribs from the back). The area is cleaned and shaved (if necessary). A local anesthetic, usually Lidocaine is injected to numb the skin and a small 1/4-inch incision is made. Under fluoroscopic x-ray guidance, a small hollow needle is inserted into the predetermined entry site. Next, a flexible guidewire is threaded through the needle and the needle is removed. A nephrostomy tube (draining catheter) is then placed over the guidewire, and the guidewire is removed leaving the catheter in place. Finally, a connecting tube is attached to the catheter and a urine-collecting bag, which can be attached to the leg.
If ureteral stenting is necessary, one of two types of stent may be employed, an internal / external stent or an indwelling (internal) stent. An internal / external stent is easily replaced or removed. The indwelling stent is less of a burden to the patient (no external bag), however, replacement or removal requires a cystoscopy by an urologist or a repeat nephrostomy by the radiologist. The internal / external stent can allow for bypass of the ureter while it heals from surgical repair or trauma. Internal / external stents are placed in the bladder via a kidney nephrostomy procedure with one end of the stent (catheter) emerging at the skin’s surface. The stent is then capped. The indwelling (internal) stent (flexible catheter) is also inserted via a kidney nephrostomy procedure, though, no external connection (bag) attached. The indwelling stent is placed in the bladder via the kidney. As a precaution for 1 to 2 days, a nephrostomy tube is secured on the skin with stitches for ready external access to the stent in case of occlusion. The tube is removed later leaving the internal stent in place.
Post-operative care after Nephrostomy Surgery:
Outpatients will be expected to stay about 8-12 hours after the procedure to make sure the catheter is functioning properly. They should plan to have someone drive them home and stay with them at least the first 24 hours after the procedure. Inpatients may stay in the hospital several days. Generally people feel sore where the catheter is inserted for about a week to ten days. Care of the catheter is important. The catheter will be located on the patient’s back, so it may be necessary to have someone help with catheter care. The catheter should be kept dry and protected from water when taking showers. The skin around it should be kept clean, and the dressing over the area changed frequently. Special care is needed in handling the urine collection bag so that it does not dislodge the catheter.
Why go to India for Nephrostomy Surgery?
Over the years, India has become a global center of excellence in urology surgery including the nephrostomy surgery. India has achieved global recognition as a pioneer in innovative nephrostomy surgery techniques to help patients who are often termed inoperable. These innovations have saved hundreds of lives across the globe. Besides the best urology hospitals available in India what attracts thousands of patients is the wide variety of tourist options available that they can visit during their recuperation from the surgery.
India will with no doubt become the global health destination. With prices at a fraction of those in the US or EU, the concept has broad consumer appeal – if people can overcome their prejudices about health care in developing countries. The reality is that Indian private facilities offer advanced technology and high-quality procedures on par with hospitals in developed nations. India is the leading country promoting medical tourism in the world. It is even moving into a new area of “medical outsourcing” where subcontractors aim to provide services to the overburdened medical care systems in western countries. Medical tourism to India is growing by 30% a year and the Indian education system is churning out an estimated 20,000 to 30,000 doctors and nurses each year. India benefits from a large staff of world-class experts and the ultra-competitive cost advantage it offers.
To know more about Hospitals in India and the Nephrostomy Surgery packages available in Hospitals,
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