Technique to assure urinary drainage through nephrostoiviy tube

Abstract

Temporary nephrostomy tube drainage is often used to divert urine away from ureteral or vesical fistulas. If there is significant ureteral obstruction, all of the urine will drain through the nephrostomy tube. However, in many patients the ureter is nonobstructed, and despite nephrostomy tube drainage, urine will continue to drain through the fistula, the pathway of least resistance. A 3 F Fogarty catheter will easily pass through a 28 F Malecot catheter, and at surgery the Fogarty catheter can be passed down into the proximal ureter (Fig. 1). After inflation of its balloon, the Fogarty catheter will obstruct the ureter and assure drainage of all urine through the nephrostomy tube. Prior to passage down the nephrostomy tube, the Fogarty catheter should be brought into the Malecot catheter through the latter’s side wall so that a drainage tube can be connected. The balloon on the Fogarty catheter should not be inflated unless there is continued drainage through the fistula site after surgery. The Fogarty balloon should be filled with only enough water to obstruct the ureter. This can be determined by serial nephrostograms.