**3.2.2 Patient's position**

266 Chronic Kidney Disease

dehydration, and the misinterpretation of caliectasis for renal cortical cyst. (LeRoy., 1996) . False positive imaging for the obstruction can be caused by parapelvic cyst, intrarenal

Retrograde pyelography may be needed to demonstrate the cause of obstruction that is either intrinsic and extrinsic. This assessment can evaluate the site, severity of obstruction

Computer tomography (CT scan) can demonstrate the information of obstruction and hydronephrosis without contrast media. All kinds of urinary calculi and other

Nephrostomy can be performed either by open operation or by closed percutaneous methods. With the development of endourologic and imaging techniques, percutaneous nephrostomy is widely used. Recently, the percutaneous nephrostomy placement became the standard of care,

Establishing safe and reliable nephrostomy tract is very important. The aim of the nephrostomy tract ranges from simple urinary drainage to intrarenal surgical operation. For percutaneous renal surgeries, some surgeons prefer a two stage surgery which can limit

A successful outcome without complications is the goal of this procedure, which requires careful preoperative planning and proper techniques. The preoperative anatomy of the patient, the nature of the urologic procedure planned and available equipment are very important.

Explore the kidney and open the renal pelvis and choose the calix which is suitable for nephrostomy. The catheter is introduced through thinned cortex into the renal pelvis.

All patients need appropriate hemostasis evaluation and urine bacteriologic assessment. Careful review and assessment of the degree of hydronephrosis, anatomic variance of the pelvicaliceal system, and relative position of the kidney are key factors for success and will reduce any potential complication of nephrostomy tube placement. This can be evaluated by previous or currents plain Kidney-Urinary–Bladder (KUB) radiography, intravenous pyelography, retrograde pyelography, computed tomogram and ultrasonographic studies. These radiographic investigations demonstrate size, number and location of renal and

ureteral calculi as well as establishing baseline renal function and other pathology.

pelvis, high urine flow state and vesicoureteral reflux. (Stables et al., 1978)

and degree of hydronephrosis especially in patients with poor kidney function.

intraperitoneal / extraperitoneal pathology can be detected by this assessment.

replacing surgical nephrostomy. (Banner et al., 1991 & Sherman et al., 1985)

bleeding, provide a clear field and let the nephrostomy tract mature.

**2.3.2 Retrograde pyelography** 

**3. Surgical approach** 

**3.1 Open nephrostomy technique** 

**3.2 Percutaneous nephrostomy techniques** 

**3.2.1 Preoperative patient preparation** 

**2.3.3 Computer tomography (CT scan)** 

Nephrostomy tube placement can be preferred in both prone and supine positions with highly successful outcome. Most patients usually undergo the procedure in the prone position with abdominal support. Supine position is selected for patients with high surgical risks such as seriously ill patients, patients with endotracheal tubes with or without ventilation, patients with congestive heart failure, patients with complicated fractures and patients who have undergone a major surgical procedure.

The advantages of prone or prone oblique with body side of targeted kidney slightly elevated are operator's hands are outside the vertical x-ray beam. (Fig. 5) With supine position with the body side of targeted kidney elevated slightly off the tabletop, the renal access can be performed with ultrasound or CT guidance.
