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Case 47 

Case 47
Chapter:
Case 47
Author(s):

Anne M. Covey

, Bradley B. Pua

, Allison Aguado

, and David C. Madoff

DOI:
10.1093/med/9780199331277.003.0047
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History

  • Bladder Cancer Status post Cystectomy and Ileal Conduit Complicated by Bilateral Uretero-Enteric Anastomotic Strictures. What catheters are shown in Figure 47.3?

Diagnosis

Case 47 Retrograde Nephrostomy Catheters

Findings

  • Bilateral nephroureteral catheters have been placed with the distal pigtails in the ileal conduit (Fig. 47.4, arrow).

  • Each catheter has been advanced through the conduit and out of the stoma located in the left lower quadrant (Fig. 47.5, arrow).

  • Both catheters have been converted to retrograde nephrostomy catheters with the retention pigtails in the renal pelvis. The catheters now drain into the stoma. The antegrade nephrostomy catheters have been removed.

Teaching Points

  • Retrograde catheters are ideal for patients with ureteral obstruction after cystectomy and ileal conduit because they drain into the stoma bag instead of antegrade nephrostomy catheters that require an additional bags for drainage.

  • Nephroureteral catheters in nonnative bladders (e.g., ileal conduits, neobladder, etc.) that are created from bowel can neither be capped nor stented because the bowel secretes mucus that occludes the sideholes of the catheter.

Management

  • After obtaining “through-and-through” access from the site of antegrade access out of the stoma with an angiographic catheter, a stiff wire is advanced from the stoma side out of the antegrade nephrostomy tract. A retrograde nephrostomy can be placed over the wire and formed in the renal pelvis as the wire is pulled back.

  • Routine exchange of all urinary drainage catheters (nephrostomy, nephroureteral catheter, ureteral stent, retrograde nephrostomy) is necessary to minimize the risk of catheter occlusion and resulting urosepsis. Typical routine exchange intervals range from 3 to 6 months.

  • For patients who tend to have encrusted catheters, a sidehole may be made in the shaft of the catheter prior to placement. This functions as an “escape route” for the next exchange, allowing for a wire to be advanced out of the catheter and up into the renal pelvis to preserve access if a wire cannot be advanced out of the end of the catheter due to encrustation.

  • The need for antibiotic prophylaxis prior to routine exchange is controvertial but widely practiced.

Further Reading

Adamo R, Saad WE, Brown DB. Management of nephrostomy drains and ureteral stents. Tech Vasc Interv Radiol. 2009;12(3):193–204.Find this resource:

Alago W Jr, Sofocleous CT, Covey AM, et al. Placement of transileal conduit retrograde nephroureteral stents in patients with ureteral obstruction after cystectomy: technique and outcome. Am J Roentgenol. 2008; 191(5):1536–1539.Find this resource: