Interventional radiologists use minimally invasive procedures to treat some kidney and bladder conditions. Services include:
Nephrostomy Tube/Nephroureteral Catheter
The kidneys produce urine that is drained into what is called a "collecting system" which then flows down a tube, called a ureter and into the bladder. However, if there is blockage preventing urine from flowing, this can lead to pain from the buildup of pressure and increased risk of infection. Both of these can also lead to injury of the kidney. Some potential causes of blockages include kidney stones, tumors, trauma/injury, blood clots and scarring from radiation.
When a blockage cannot be fixed or treated surgically, a minimally invasive procedure can be done to place a tube through the skin on your back and into the kidney which will then allow the urine to drain out of your body. This tube is called a nephrostomy tube. Another type of tube is a nephroureteral catheter which is a longer version of the nephrostomy tube except it travels from the skin into the kidney and has an additional length of tubing that goes down the ureter and into the bladder. Your team of physicians will decide which one is more appropriate for your condition.
Most often, this procedure is done under moderate sedation with IV medications ("twilight sedation") but in some cases, some patients may require general anesthesia. The procedure can take as little as 30 minutes but more complex cases may take one to two hours. Because of the risk of urine clogging the inside of the tubes, patients are required to flush these tubes daily and return for routine exchanges of the tube every two to three months. While some patients may need these tubes for the rest of their lives, there are many who will only need these tubes temporarily; once treatment is completed, the tubes can be removed.
A small sample of tissue is sometimes required to make a medical diagnosis, which is the purpose of a biopsy. In patients with kidney disease or kidney failure, a biopsy of the kidney tissue may help to determine the cause of the disease or injury to the kidney. In other cases, a biopsy of a tumor growing on the kidney will help in differentiating cancerous versus benign tumors.
A kidney biopsy is performed with guidance using either ultrasound or a CT scan. You will be placed in a position (either on your stomach or on your side) that will allow the biopsy physician to reach the kidney. If needed, a small amount of sedative and pain medication may be given through your IV. Your skin will also be numbed up with a local anesthetic. Once an adequate sample of your kidney or kidney tumor is obtained, instruments will be removed. You will then rest in the recovery area for a period of time. The biopsy procedure itself can take as little as 30 minutes, and if no problems arise during the recovery period, you can go home that same day.
Cancer involving the kidney has traditionally been treated with surgical removal of either the entire kidney (total nephrectomy) or only a portion of the kidney containing the tumor (partial nephrectomy). However, in some patients who are not candidates for major surgery, there are now minimally-invasive procedures to treat these kidney cancers.
These minimally-invasive techniques are referred to as tumor ablation, but more specifically, the technique where the tumors are frozen is called cryoablation. When having a cryablation procedure, a patient is placed under general anesthesia and then positioned in a CT scanner. The CT scanner will help the physician to place thin probes through the skin and into the tumor. Sometimes, ultrasound may also be used for guiding the probes. Once the tumor has been adequately covered with probes, the freezing process begins. After the tumor has been frozen, the probes are removed and the patient will recover in the post anesthesia care unit.
The procedure can take between one to three hours. Patients are admitted to the hospital overnight for close monitoring. The following morning, if the patient is doing well and pain and other symptoms are well controlled with only oral medications, the patient will go home. The majority of patients will only require an overnight stay. After cryoablations, patients are closely followed with periodic clinic visits, imaging studies (CT or MRI), and blood work.