Percutaneous nephrostomy (PCN) is a basic urological procedure that can be life-saving for decompressing the kidney collecting system. While basic, PCN can sometimes be challenging. USG guidance is a common technique for PCN and there are several tips that can help, such as using a prone position, USG guide if available, convex probe, and jerky needle movements to see kidney movement. Proper wire and dilator technique is important to safely place the pigtail catheter in the collecting system.

1. USG guided Percutaneous Nephrostomy
(Fluroless) – Tips and Tricks
Dr Nitesh Jain
Endoscopic, Laparoscopic & Robotic Urologist
Apollo Hospital , Chennai (India)
www.urocarechennai.com
drniteshjain@yahoo.com
+919445561466

2. Percutaneous Nephrostomy
• PCN can be life saving
• Basic urological procedure which all urologist should know
• Inspite basic it is challenging at times
• Decompression of the collecting system
• Can be done Fluroscopy, USG, CT guided

4. Tips..
• USG guided PCN can be done in both Prone or supine, but probably
prone is easier
• USG “Guide” if available is helpful but not necessary
• Convex probe are useful
• Diamond tip needle are better than bevelled one
• Use jerky movement to see the movement of the kidney and
direction of the needle
• Once inside the PCS , can instill contrast if fluoroscopy is available to
complete the procedure

5. Tips
• Insert the guide wire, once in PCS most of the time patient with
complain of mild pain
• While dilating keep moving the wire to see if you have engaged the
wire between the PCS and the dilator, at that point the wire
movement will stop
• Repeat the above step at time of pigtail insertion as well
• Secure the PCN nicely, away from bony points