Retrograde nephrostomy: experience with 2 techniques.

An attempt was made to establish a percutaneous nephrostomy in 47 consecutive patients using retrograde techniques. In all patients the Lawson nephrostomy system was used first. A steerable guide wire is used to position a polytetrafluoroethylene (Teflon) catheter in a suitable calix. A penetrating wire then is passed through the catheter and advanced to the skin. The catheter then is advanced over the wire to the abdominal wall and locked to the wire. Traction on the wire advances the catheter to the skin to establish the nephrostomy tract. If the Lawson system could not be used successfully, the Hunter-Hawkins nephrostomy system was used. Of the patients studied 3 required bilateral nephrostomy and 1 required 2 nephrostomies in the same kidney, for a total of 51 attempted procedures. Of the 51 attempts 49 (96 per cent) were successful. Nephrostomy was done for stone removal in 46 cases and was successful. The Lawson system was used successfully in 43 of the 49 successful nephrostomies (88 per cent). The Hunter-Hawkins system was successful in the remaining 6 patients. The mean duration of the nephrostomy procedure was 45.9 minutes and the mean fluoroscopy time was 2.7 minutes. No patient suffered any complication related to the nephrostomy insertion. Retrograde nephrostomy is a quick, safe procedure that requires little radiation and is well suited to the undilated collecting system.