What Is Pyelostomy?
Pyelostomy is a rarely performed surgical procedure in which an external catheter is fitted into the renal pelvis of the kidney to drain the urine. It is different from a nephrostomy tube in which the external catheter passes into the renal pelvis without directly passing through the renal parenchyma. It is a surgical procedure of forming an artificial opening in the renal pelvis to drain urine.
When Is a Pyelostomy Performed?
A pyelostomy is performed when there is a presence of blockage that keeps the urine from passing from the kidneys to the ureter. The normal flow of urine is from the kidneys to the urinary bladder via ureters. However, there are certain conditions in which urinary obstruction is present that prevent the flow of urine. The most common cause of blockage includes a tumor, especially ovarian cancer and colon cancer. It is also performed in other conditions, such as hydronephrosis, kidney stones, and pyonephrosis. It is also performed in cases of bilateral hydronephrosis accompanied by dilated and atomic ureters. It is a life-threatening condition and requires medical intervention for urine drainage.
It is also performed in the case of urinary drainage obstruction with inefficient urinary transport to the bladder. In addition to the presence of urinary obstruction, these patients have damaged renal parenchyma. Therefore, a high urinary division approach is required to prevent further damage associated with the placement and maintenance of a nephrostomy tube. This procedure is a simple method of establishing tubeless drainage from the kidney. A plastic urinary bag is placed at the opening to collect the urine.
Pyelostomy is also performed in obstructive nephropathy. It is a condition in which renal parenchyma damage results from obstruction to the urine flow anywhere along the urinary system. Long-term obstruction of the urinary flow causes chronic renal disease. In such cases, a pelvic pyelostomy is done to drain the urine. Pyelostomy helps in controlling infection due to urine buildup, normalizes blood chemistry, decreases back pressure changes, and improves renal function. A pyelostomy must be done before irreversible damage to renal parenchyma occurs.
Laparoscopic pyeloplasty is widely used and has similar success rates as that of open surgery. A double J tube, ureteral stent, nephrectomy tube, or no tube is inserted through the incision to drain the urine. It is a safe and reliable technique with a pyelostomy tube and has the advantage of removal without anesthesia.
How Is a Pyelostomy Surgery Performed?
-
A kidney ultrasound and X-ray must be carried out to know the exact location of the renal pelvis.
-
If one has any medical conditions or if they are pregnant, then they will be taken for examination.
-
If one has an allergy to anesthetic medication, then one should inform the surgeon prior to the surgery.
-
The exact time and preparation for the surgery will be informed by the physician during the time of admission into the hospital.
-
Do not drink or eat anything before the surgery.
-
One might need to fast for about four hours prior to the surgery.
-
Be prepared with loose-fitting clothes as the urine bag will be attached to the thigh before one leaves the hospital.
-
An intravenous line is obtained to maintain circulation and prevent blood clots.
-
The surgical site is shaved just prior to the surgery.
-
An anesthesiologist obtains anesthesia once informed by the surgeon.
-
After the surgery, pulse and blood pressure are measured.
-
The urine output from the stoma (opening into the renal pelvis) is checked.
-
The intravenous line is still maintained to provide nutrients after the surgery also. It is removed once the patient can eat and drink normally.
-
One can drink and eat normally as and when advised by the surgeon.
-
The next day after the surgery, the person will be able to wake up from the bed and can eat and drink normally if advised by the surgeon.
-
Antibiotics and painkillers will be advised by the surgeon to prevent infection and reduce the pain from the surgery.
-
The remainder of the wound is closed in layers with a caught and a small penrose drain is placed beside the pyelostomy, through the suture line.
-
A temporary plastic urinary drainage bag is placed over the opening until the wound healing takes place.
-
Swimming, doing physical exercises, straining and twisting the torso, playing tennis, and having saunas are not allowed until the surgeon asks to do so.
What Care Must Be Taken When a Nephrostomy Tube Is Present?
-
Pyelostomy offers access to the kidney so that urine can be drained when another approach is not possible. In this procedure, an incision is made with a small blade such that the renal pelvis and calyces are left open. Then a catheter is placed directly through the incision into the renal pelvis.
-
There is always a risk of infection and blood loss associated with the surgery therefore it is very necessary to check for increased blood loss during the surgery.
-
Care must be taken so that the wound heals properly without any signs of infection and bleeding around it.
-
Care must also be taken about the wound drain and urine output for a speedy recovery.
-
If there is no pain or leakage from the nephrectomy tube, then it can be removed.
What Are the Risk Factors Associated With Pyelostomy?
-
Bleeding around the kidney.
-
Problems with kidney function.
-
Kidney infection.
-
Displacement of the nephrostomy tube inserted inside the kidney.
-
Decreased urinary output due to infection.
Conclusion
A pyelostomy Is a medical procedure in which an opening is made in the renal pelvis to drain the urine. In this method, an external tube is placed to drain the urine, which is attached to the catheter bag. Also, in this procedure, an incision is not made through the renal parenchyma, unlike the nephrostomy procedure. The remaining bond is stitched, and a temporary urinary bag is placed over the opening until the bond healing takes place. It is advised in cases of urinary obstruction with damaged parenchyma. An example of such a case is hydronephrosis with damaged parenchyma.
