It is uncommon for a nephrostomy to be inserted simply for purposes of performing a nephrostogram. The more likely clinical scenario is that renal puncture has already been performed for other indications, and a nephrostogram obtained while it remains in position. Indications for a nephrostogram include—

• Assessment of an obstructing lesion (e.g., calculus, tumor, ureteric strictures or UPJ obstruction) when other radiographic modalities have been insufficient (Fig. 3.8a)

• Assess residual stone fragments following percutaneous stone surgery

• Assess response to treatment (e.g., after BCG/mitomycin therapy for ureteric tumor)

• Delineation of ureteric fistulas

Other general indications for nephrostomy insertion also include—

• Drainage of pyonephrosis

• Relief of ureteric obstruction

• Prior to percutaneous nephrolithotomy (PCNL)

• For antegrade ureteric stenting (Fig. 3.8b)

• Performance of perfusion pressure test (Whitaker's test)

FIGURE 3.8. Nephrostogram—(a) radiolucent calculi in the upper pole and proximal ureter, (b) nephrostogram and antegrade ureteric stent insertion with obstructing proximal ureteric stone (Courtesy of Dr A Bradley, Wythenshawe, Manchester)

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