Fallbericht: Perkutane Nephrostomieund und instrumentelle Steinentfernung in Lokalanästhesie

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Abstract
Percutaneous nephrostomy under ultrasonic guidance is a reliable method for suprapublic urinary diversion with a low complication rate. Indications are acute or chronic obstruction of the upper urinary tract from the intravesical ureter to the neck of renal calyx. Etiology of the obstruction may be a renal or ureteral calculus, an intrinsic or extrinsic (radiogenic, inflammatory, tumorous) stenosis of the ureter or a functional ureteral obstruction (megaureter, reflux). In the reported case of an ultrasonically guided percutaneous nephrostomy, the indication for urinary diversion was blocking renal calculus with urosepsis. Any operative procedure was contraindicated because of several internal disease. With sufficient urinary drainage, fever subsided and gradual dilatation of the nephrostomy channel with instrumental extraction of the calculus could be performed under local anesthesia. Percutaneous nephrostomy is recommended for urinary diversion in cases of blocking renal calculi with infection if an operation cannot be performed. This approach bears the option of a later cure by intrumental extraction, litholypaxy or chemical dissolution of the stone.

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