What Is Percutaneous Renal Puncture?

Percutaneous renal puncture is usually used when approaching the kidney through the urethra is unsuccessful or difficult. Retrograde approach is the term used for approaching the kidney through the urethra.

Your doctor may do percutaneous renal puncture for medical conditions, such as:

• Urinary tract obstruction
• Injury to the ureter
• Urine leak
• Treatment of kidney stones
• For placing the stent (a tiny tube placed into a hollow structure in the body to keep it open) in the ureter
• Diagnostic testing
  • Antegrade pyelography
  • Whitaker test

Generally, everyone can undergo percutaneous renal puncture; however, your doctor may consider you unfit for the procedure if you:

• Have uncorrectable bleeding issues
• Are uncooperative
• Have severe respiratory disease
• Have uncorrected severe hyperkalemia (high blood potassium levels)

Percutaneous nephrostolithotomy (or nephrolithotomy) is the passing of a special medical instrument through the skin into the kidney. This is done to remove kidney stones.

Most stones pass out of the body on their own through urine. When they do not, the healthcare provider may recommend these procedures.

• You will be asked to lie on your stomach on a table.
• You will be given a shot of local anesthetic medication called lidocaine around the area where the insertion will be made. This medication helps numb the operative site. Intravenous medication may be administered to help you relax and reduce pain.
• Your doctor will insert a needle into the skin. Next, a catheter will be passed through the needle so that it reaches the kidney. You may experience mild pressure or discomfort during the insertion.
• Live X-rays of the region will guide the doctor while placing the catheter correctly.

If your doctor has planned a renal puncture to remove kidney stones, the procedure is called percutaneous nephrostolithotomy (or nephrolithotomy).

• Instead of local anesthesia (lidocaine), the doctor will administer general anesthesia through your intravenous line so that you will remain asleep throughout the procedure and feel no pain.
• The doctor makes a small incision into the skin on the flank or back. They then insert a needle so that reaches the kidney. This opening will be dilated and special instruments will be inserted to break the kidney stones and remove them.
• After the kidney stones are removed, a tube called a nephrostomy tube is placed in the kidney. Another tube, called a stent, is placed in the ureter to drain urine from the kidney.
• The place from where the catheter is inserted is covered with a dressing. The catheter is connected to a drainage bag, which is placed near the body.

• You will be advised bed rest for about two to four hours. During this period, you will be regularly monitored for vital signs: blood pressure, heart rate, and respiratory rate.
• Your doctor will administer analgesics at regular intervals so that your pain gets alleviated.
• You will be hydrated well through intravenous fluid or saline supply. This is particularly done for urinary tract obstruction.
• You may find bloody urine for the first two to three days after the procedure and that is normal.
• You will have to replace your catheters every three months.
• You will have to take care while handling the catheter to avoid its displacement. If you think the catheter has slipped from its position, you need to seek urgent professional help.

A percutaneous renal puncture can cause complications in only up to 10 out of every 100 patients. The medical team takes utmost care to avoid complications, but the possibility of having them cannot be ignored.

The possible complications include:

• Bleeding
• Catheter obstruction
• Catheter displacement
• Pneumothorax (collection of air in the cavity between the lung and the outer membrane of one or both the lungs)
• Bowel injury
• Peritonitis (inflammation of the peritoneum, the lining of the inner wall of the abdomen, and cover of the abdominal organs)
• Urine leak
• Liver injury
• Spleen injury
• Sepsis (widespread, life-threatening infection)