The insertion of a percutaneous nephrostomy is indicated for short-term urinary diversion in the event of
- a kidney outflow obstruction or
- urinary fistula after ureteral injury
intended.
Thecauses of kidney drainage disorders are
There are no absolute contraindications to percutaneous nephrostomy, i.e. situations in which treatment is not possible. Blood clotting disorders are a relative contraindication. However, in patients with urosepsis and consecutive disseminated coagulopathy, PCN can be life-saving.
- Can be performed quickly
- No extensive preparation
- Local anesthesia and therefore no general anesthesia
- Safe procedure and therefore with few complications
- Ultrasound is the only imaging procedure required
- PCN is the basis of minimally invasive procedures on the renal hollow system
The kidney is punctured in a renal calyx. During the procedure, the surgeon monitors the guidance of the instruments via ultrasound or X-ray. If the puncture is successful, the surgeon inserts a plastic tube through the renal calyx into the renal pelvis.
The urine then flows out via the drainage catheter, which is attached to the skin, and is collected in a urine bag.

In a percutaneous nephrostomy, catheters drain the urine directly from the kidneys © peterschreiber.media | AdobeStock
The procedure involves the following steps:
- Lateral positioning of the patient
- Sterile draping
- Sonographic visualization of the congested kidney with a sterile puncture transducer in the axillary line
- Determination of the puncture site and the direction and depth of the puncture
- Local infiltration of the skin with an anesthetic
- Incision of the skin
- Puncture of the congested kidney under permanent sonographic control
- the needle tip reflex is visible in the congested renal pelvis
- Aspiration of urine
- Advancement of the semi-directional guide wire through the puncture needle
- the wire can be visualized sonographically in the renal pelvis
- Withdrawal of the puncture needle
- The pigtail catheter is now advanced into the renal pelvis via the wire
- renewed aspiration of urine
- Fixation of the catheter to the skin with a thread
- dressing
The catheter is changed using a wire as a guide under X-ray control.
The replacement intervals are subject to patient-oriented fluctuations. The PCN should not be changed routinely at fixed intervals, but rather according to individual requirements. These are based on
- Diuresis,
- soiling,
- tendency to incrustation and
- infections.