Home / Site Map / Vulva and Introitus / Vagina and Urethra / Bladder and Ureter / Cervix / Uterus
Fallopian Tubes and Ovaries / Colon / Small Bowel / Abdominal Wall / Malignant Disease: Special Procedures

Bladder and Ureter

Insertion of Suprapubic Catheter

Retropubic Urethropexy:
and Burch Operations


and Ureteroneocystostomy
With Bladder Flap

End-to-Side Anastomosis

Intestinal Loop
Urinary Diversion



Clam Gastrocystoplasty

Percutaneous Nephropyelostomy 

A suture ligature, excessive radiation, scarring from radical surgery, or clamping the ureter all lead to hydroureter and eventual hydronephrosis and loss of the kidney. If the ureter is transected, urinary ascites will result and eventually lead to infection and abscess.

The incidence of injury to the ureter associated with pelvic disease and/or surgery ranges from 0.3% to 5%.
Injury to the ureter is a medical emergency. Time is of importance, since for every hour that the kidney is obstructed, there is further damage to the renal collecting system.

A straightforward and simple procedure has been developed that avoids major surgery and relieves the sequelae of ureteral injury and obstruction in most cases-percutaneous needle nephropyelostomy.

Physiologic Changes.  Percutaneous nephropyelostomy relieves the obstruction and prevents death of the renal nephron unit while corrective surgery can be planned.

Points of Caution. Fluoroscopy and ultrasound are used to guide the needle through the cortex of the kidney into the renal pelvis. Once the needle is in the renal pelvis, the guidewire should be advanced down into the urinary tract as far as the bladder if possible.

An attempt should be made to totally implant the "J" or pigtail stent. Not having a catheter through the renal parenchyma will reduce repeated episodes of gross hematuria. In some cases, however, this cannot be done, and the stent must be brought out through the renal cortex, flank wall, and skin and connected to a drainage bag.


The patient is placed in the prone position and rolled into the modified lateral decubitus position with the hip and the knee flexed. The side representing the normal kidney should be down, with the hip and the knee on that side extended. Dye for an intravenous pyelogram has been injected. The hydronephrosis is seen in the right kidney.

Under fluoroscopic control, the 16-gauge Tuohy-type needle should be advanced through the abdominal wall in the costovertebral angle area. The renal cortex should be perforated, and the needle should be advanced into the renal pelvis. Injection of a small amount of x-ray dye will confirm that the needle is in the renal pelvis. At this point, a flexible guidewire is threaded through the needle, down the ureter, under fluoroscopic control. The area of damaged ureter is approached, and if possible, the guidewire is manipulated through this area of damage into the bladder. If this is not possible, the guidewire should be threaded as close as possible to the area of damage.

The needle is withdrawn, and a double-J or pigtail catheter is inserted over the guidewire through the flank wall, through the renal cortex, into the renal pelvis, and down the ureter. Ideally, the double-J catheter should be inserted through the area of ureteral damage into the bladder. Injection of small amounts of contrast medium can confirm its position.

By using a tubular pusher over the guidewire, the surgeon can advance the proximal end of the "J" catheter through the flank wall and the renal cortex into the renal pelvis. This leaves the proximal end of the catheter stent in the renal pelvis and the other end in the bladder.

Copyright - all rights reserved / Clifford R. Wheeless, Jr., M.D. and Marcella L. Roenneburg, M.D.
All contents of this web site are copywrite protected.