Nephrostomy
What is a nephrostomy and what is its relation to oncology?
What is the purpose of performing a nephrostomy?
What are the advantages of performing a nephrostomy at "Doctor Dilanyan's Clinic"?
and what relation does it have to oncology?
The function of the kidney is to filter blood from waste products. However, if urine flow is obstructed, these toxins remain in the blood and poison the body. Moreover, the patient is already in a critical condition due to oncological pathology and previous chemotherapy, and kidney failure exacerbates the situation. Nephrostomy not only helps to fight for the patient's life but also prevents death from kidney failure.
But how is a nephrostomy actually performed? It's a whole surgery, under anesthesia...
- Not exactly.Previously, placing a nephrostomy tube required an incision in the lumbar region. However, in some clinics, this method is still practiced. Nevertheless, in high-tech centers like "Doctor Dilanyan's Clinic," a procedure called percutaneous nephrostomy is performed.
This intervention does not require general anesthesia; local anesthesia is sufficient, and we also administer intravenous pain management to ensure the patient's comfort – the patient should not feel pain. Percutaneous nephrostomy does not pose the risk of bleeding or the formation of urinary leaks and is well tolerated by patients. It's worth noting that after nephrostomy, patients can go home on the same day.
The essence of the technique is revealed in its name "percutaneous nephrostomy" – i.e., for the placement of the nephrostomy tube into the kidney, only a puncture is required – the insertion of a special needle into the kidney. Then, a guide wire is introduced into the kidney through the needle, the needle is removed, and the nephrostomy tube is placed over the guide wire.
It sounds terrible, "a tube from the kidney." Is the patient doomed to wear this tube for life?
— Unfortunately, in some cases, yes. However, it's important to remember that a nephrostomy often provides an opportunity to rid a person of the primary disease, such as a tumor. Consequently, after chemotherapy or surgery, we can attempt to restore the patency of the ureters and remove the nephrostomy tube from the patient. In "Doctor Dilanyan's Clinic," we have accumulated significant experience in such operations, and we are quite successful in removing external tubes from most of our patients. At the very least, we use ureteral stenting with a long-term stent. The latter is placed in the ureter and connects the kidney to the bladder. If this is not possible for various reasons, we utilize all of our experience in complete ureteral reconstruction.
And why not perform ureteral stenting from the beginning?
— In some cases, when there is hope that the stent will pass through the ureter, we do just that.
Moreover, immediately after placing the nephrostomy, we insert a guidewire into the ureter, and if it passes into the bladder, we immediately place an oncological long-term stent. However, unfortunately, there are quite common situations where the tumor compresses the ureter too much, and we are forced to leave the nephrostomy.
Let me provide a fairly standard example for our clinic:
A 64-year-old woman with a tumor of the intestine compressing both ureters. She was experiencing lower back pain, unable to sit, sleep, or eat, and had a fever. Lab tests showed signs of inflammation and kidney failure, and she still had surgery and chemotherapy ahead for her primary oncological condition. However, she would not have tolerated surgery or chemotherapy in her current condition. On ultrasound, we observed massively dilated kidneys with stagnant urine. The ureters were so compressed by the tumor that ureteral stenting was out of the question. Nephrostomies were placed. After some time, our oncologists operated on her, removing the tumor compressing the ureters. During the surgery, we restored the patency of the ureters and removed the nephrostomy from the patient, discharging her without any oncological disease or tubes.
What are the advantages of seeking treatment at "Doctor Dilanyan's Clinic" for patients in need of nephrostomy?
— "Doctor Dilanyan's Clinic" specializes in providing assistance to oncological patients.
We have extensive experience in performing nephrostomies for cancer patients and are knowledgeable about the specific care required for these patients. Furthermore, in our work, we adhere to the recommendations of the European Association of Urology (EAU) and the European Society for Medical Oncology (ESMO), which obliges us to comply with European standards of quality and safety in conducting all procedures.
It is important to note that we use nephrostomies and stents from the world's leading manufacturers: PorgueColoplast, Urotech, and Cook. Our main advantage, in my opinion, is our focus on the outcome and quality of life of the patient: not only mechanically placing the nephrostomy but also, whenever possible, normalizing the patient's quality of life and removing any external tubes protruding from the body. We are always there for the patient.
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