Authors reply on "Ultrasound guided percutaneous nephrostomy".

Sir,

Thanks to Dr. Ganpule for his keen interest[1] in the article titled ‘Percutaneous nephrostomy by direct puncture technique: An observational study’.[2]

We have merely described a technique of percutaneous nephrostomy (PCN) and our experience. Position of the patient, prone or supine, depends upon whether the patient is feeling any discomfort or not and the operating physician's preference.

We started the procedure to save the life of a patient who was unable to procure the standard nephrostomy set. Pigtail catheters of 6 F to 8.5 F are easy to administer with less complications, though with a relatively increased chance of blockage as correctly pointed out by Dr. Ganpule. The incidences of tubal blockage and dislodgement were 13% and 6% respectively.

We performed lower polar calyx puncture most of the time and upper or middle calyx puncture in only few cases. The choice of calyx depends upon the accessibility. The difference in our choice of calyx is probably due to the difference in the patient's position.

We have not used bolsters till now. However, it may be tried if it helps to reduce the incidence of bowel injury. But we are not sure about the use of pre-procedural diuretics. If the PCN is unsuccessful, immediate open nephrostomy may be required.

Lastly, we think that it is the procedure that matters and not the person, whether interventional radiologist or urologist.