Percutaneous Drainage (Cystostomy, Nephrostomy, and Cholecystostomy Tubes)
Cystostomy tubes are regularly placed during surgery to manage veterinary patients with urinary obstructions or to divert urine away from a traumatized urethra. Occasionally, these patients are severely debilitated and even a relatively short period of general anesthesia would be dangerous. A variety of cystostomy tubes and techniques are available to place these tubes quickly and safely with a percutaneous approach in order to establish urine drainage and/or diversion. Locking-loop drainage catheters have been used for such purposes in veterinary patients. These tubes can be placed via palpation alone, or with fluoroscopic or ultrasound guidance, and can be placed in the emergency room setting.
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Figure 7. Percutaneous nephrostomy tube placement for bilateral ureteral obstructions in a cat. (A) Ultrasound-guided pyelocentesis with 18 gauge catheter (white arrows) and contrast pyelogram demonstrating extremely distended renal pelvis (RP) and proximal ureter. (B) Fluoroscopic-guided guidewire (GW) placement through catheter and removal of catheter over-the-wire. (C) Fluoroscopic-guided placement of locking-loop drainage catheter over the guidewire with subsequent removal of guidewire. (D) Radiograph following repeat procedure on other kidney and drainage of both renal pelvices (asterisks). |