Urology Unit, Ospedale Galliera, Genova.
Arch Ital Urol Androl. 2020 Oct 1;92(3). doi: 10.4081/aiua.2020.3.207.
The removal of an encrusted nephrostomy tube can be a challenging maneuver. Urological literature is very bare in detailing techniques for removal of entrapped percutaneous catheters. We present a simple, safe and non-invasive technique of nephrostomy removal using a vascular introducer sheath, useful to manage complicated situations such as nephrostomies blocked for severe encrustations or disabled in their self-locking system.
The nephrostomy tube is cut and the stump is passed with a suture needle. The suture is passed through the inner vascular introducer sheath tip, and the introducer is then removed. The introducer sheath is advanced over the nephrostomy until joining the pigtail segment, under fluoroscopy guidance. Thus the suture is pulled out with strenght to contrast the opposite stiffness of the encrusted coil, until the nephrostomy has safely come out.
The sheath exchange technique is quick, involves less manipulation through the perirenal fascia and kidney, and is suitable for different conditions of entrapped nephrostomies.
去除包裹的肾造瘘管可能是一个具有挑战性的操作。泌尿科文献在详细描述处理被困经皮导管的技术方面非常匮乏。我们提出了一种简单、安全且非侵入性的肾造瘘管去除技术，使用血管导入鞘，可用于处理复杂情况，如因严重结石形成而堵塞或其自锁系统失灵的肾造瘘管。
将肾造瘘管剪断，残端用缝线针穿过。缝线穿过内置血管导入鞘尖端，然后将导入器取出。在荧光透视引导下，将导入鞘推进到肾造瘘管，直至与猪尾段相接。然后用力拉出缝线，以对抗包裹的线圈的相反硬度，直到肾造瘘管安全拔出。
鞘管交换技术快速，通过肾周筋膜和肾脏的操作较少，适用于不同情况下的肾造瘘管被困。
