Percutaneous Nephrostomy (PCN)
Emergency kidney drainage through the skin to relieve infected ureteric obstruction — performed under local anaesthesia in 30–60 minutes, immediately decompressing the obstructed kidney.
What is Percutaneous Nephrostomy (PCN)?
Percutaneous Nephrostomy (PCN) places a drainage tube directly into the renal pelvis through the skin under ultrasound and fluoroscopic guidance, providing immediate relief of urinary obstruction and infected urine drainage. It is the fastest and most reliable method to decompress an obstructed infected kidney, preventing life-threatening urosepsis from progressing to multiorgan failure. PCN can be performed under local anaesthesia with sedation in critically ill patients who cannot tolerate general anaesthesia. It provides immediate antegrade access for subsequent definitive interventions including ureteric stenting and stone retrieval.
How the Procedure Works
Imaging & Planning
Ultrasound confirms hydronephrosis; optimal posterior lower-pole calyx identified, avoiding major vessels and pleural reflection above the 12th rib.
Local Anaesthesia & Positioning
Skin and subcutaneous tissues infiltrated to renal capsule; IV sedation provided; patient positioned prone or oblique depending on anatomy.
Needle Puncture
18-gauge Chiba needle advanced under real-time ultrasound guidance directly into target calyx; purulent urine aspiration confirms correct position.
Tract Creation
Guidewire coiled in renal pelvis through the needle; tract dilated over wire using serial fascial dilators to accommodate the drainage tube.
Tube Placement & Drainage
Nephrostomy tube placed into renal pelvis; pigtail formed; tube secured to skin with suture and connected to drainage bag; drainage begins immediately.
Outcomes
Who Needs This Treatment?
- →Patients with urosepsis from an obstructed infected kidney where every hour of delay risks multiorgan failure.
- →Those with pyonephrosis — a kidney full of pus — requiring urgent surgical drainage without delay.
- →Patients in whom cystoscopic DJ stenting has failed due to tight obstruction or anatomical difficulty.
- →Pregnant women with obstructing stones and infection where stenting has failed.
- →Critically ill patients who cannot tolerate general anaesthesia but require urgent renal decompression.
- →Those with complete ureteric obstruction from pelvic malignancy or fibrosis requiring palliative drainage.
"PCN is one of the most important emergency tools in urology. In a septic patient with an obstructed kidney, placing a nephrostomy within the hour can be the difference between recovery and organ failure — I have seen it save lives."
— — Dr. Vipin Reddy, Consultant Urologist, Andrologist & Renal Transplant Surgeon
Common Questions
Frequently Asked
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