Indications

• Decompress and drain urinary obstruction

• Urinary diversion (ureteral injury, fistula, hemorrhagic cystitis)

• Percutaneous access for Urology (lithotripsy, double J stent placement, etc.)

Contraindications

• Uncorrectable coagulopathy (high risk procedure for bleeding)

• Untreated urosepsis (should be stabilized as much as possible, as intervention has potential to send pt into septic shock)

Imaging Review

• Review CT or US, which is usually already available.

• Evaluate standard vs variant anatomy (Transplant pelvic kidney, horseshoe kidney, or duplicated collecting system)

• Is the collecting system sufficiently dilated and is the body habitus amenable to US-guided needle access? If not, then anesthesia can be considered, given longer more painful procedure times.

Tips for Workup

• When placed for urinary obstruction, especially when infection suspected, these tubes have serious potential to precipitate septic shock, even when abx are given. Note any abx allergies and sensitivities from recent urine cx. Obtain anesthesia support if pt bordering on unstable

• Reverse anticoagulation if possible. Those who cannot be reversed require a high-level discussion about risks of hemorrhage vs benefit of the procedure.

• Note any contrast allergies. Air can be used as an alternate agent if necessary, but premedicate if there is enough time.

• Consent: Sepsis, hemorrhage (pseudoaneurysm, AV fistula), bowel injury, pleural effusion / pneumothorax, additional infection.