How do I perform a percutaneous nephrostomy for kidney drainage?

Objectives. Insertion of a nephtostomy belongs to the elementary procedures in urology. Often performed as an emergency for life threatening conditions, every urologist should acquire the necessary skills. During the last few years, the technique has been updated. The aim of this didactic article is to offer useful details for its realization, based on the experience of our team. Material and methods. Patient is positioned in Valdivia position: in dorsal decubitus, the lumbar region on the site to be operated is elevated 20 with the help of an inflatable pillow (Pelvic Tie). The puncture is performed under combined ultrasound and fluoroscopic control. We use a Kolibri (R) nephrostomy kit which includes an 18 gauge Chiba type puncture needle, a 70-cm Teflon coated guidewire, and a nephrostomy tube equipped with a hollow metallic stylet. The puncture is usually done through the inferior-posterior calix, but in particular cases through the mid or superior calix. Results. Supine position makes nephrostomy insertion simpler and safer. Technical precisions, tips and tricks are detailed. Conclusions. Training in nephrostomy placement is crucial for future urologists. Besides its utility in emergency situations, this technique represents an unavoidable step for those wishing to learn performing percutaneous nephrolithotomy.