Percutaneous nephrostomy (PCN) is an interventional procedure used to decompress the renal collecting system through temporary drainage of an obstructed system. It is done under imaging guidance such as fluoroscopy, ultrasound, or CT. PCN is indicated for obstructive uropathy from various benign or malignant causes, and can provide access for chemotherapy, antibiotics, stent placement, or diagnostic procedures. The key steps of PCN involve pre-procedural evaluation and imaging, local anesthesia, needle puncture of the kidney under imaging, insertion of a guidewire and dilators, and placement of a pigtail drain catheter under imaging guidance. Complications can include minor issues like hematuria or urine leak, or major issues such

1. Percutaneous
Nephrostomy(PCN)

2. Introduction…
•An interventional procedure that is used mainly in
the decompression of the renal collecting system.
•Percutaneous nephrostomy catheter placement
for the temporary drainage of an obstructed
collecting system
•Done under fluoroscopy, ultrasound or computed
tomography guidance

3. Indication
Obstructive Uropathy
Benign causes:
• Impacted Urecteric calculi/
Pelvic calculi with secondary
hydronephrosis
• Ureteric stricture
• Pelvic ureteric junction
obstruction
• Hydronephrosis associated
with pregnancy
• In transplant patients
• Retroperitoneal fibrosis
• Urosepsis
• Pyonephrosis

4. • Malignant Causes
•HN due to tumor of urinary tract
•HN secondary to carcinoma cervix/ prostate.
• Urinary diversion in an attempt to heal conditions like:
malignant/inflammatory fistula, urinary leak or
fistulas d/t trauma and hemorrhagic cyst.

5. • For providing route of
access:
• Chemotherapy
• Antifungal/antibiotic
therapy
• Benign stricture dilatation
• Stone retrieval
• Antegrade ureteral stent
placement
• Endopyelotomy
• For diagnostic procedures
• Antegrade pyelography
• Biopsy
• Whitaker test

6. Procedure
•Pre procedural evaluation
- Review all imaging available , assess renal anatomy and
safe route to kidney
- CBC and coagulation profile
- Informed consent
- Peripheral IV access
- Broad spectrum Abx 1-4 hours prior to procedure
- Positioning : Prone, prone oblique or lateral

7. Equipment
• USG or fluoroscopy guidance
• LA 1% or 2% lignocaine
• 18 gauge puncture needle
• 0.035 inch stiff guidewire
• Water soluble contrast media
• Dilators
• Pigtail drain (8 French)

8. Procedure
•

9. Key steps in PCN

10. Contd…

11. Contraindications
• Absolute contraindications
• usually none
• Relative contraindications
• uncorrectable bleeding diathesis (abnormal coagulation
• uncooperative patient
• severe respiratory disease
• uncorrected severe hyperkalemia and/or metabolic
• urgent haemodialysis can correct metabolic derangement before
insertion

12. Complication
Minor
• Transient hematuria, which
occurs in virtually all patients,
and small perirenal
hematomas that can resolve
on conservative management
• Urine leak
• Pain and fever.
Major
• Hemorrhage
• Sepsis
• Pneumo-, hydro-, or
hemothorax and empyema
are uncommon
• Bowel injury and peritonitis

13. References
• https://radiopaedia.org/articles/percutaneous-nephrostomy

14. THANK YOU