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Loop Nephrostomy with the Cummings Catheter
Vol. 117, May Printed in U.SA.
THE JOURNAL OF UROLOGY
Copyright © 1977 by The Williams & Wilkins Co.
LOOP NEPHROSTOMY WITH THE CUMMINGS CATHETER JAY Y. GILLENWATER From the Department of Urology, University of Virginia Medical Center, Charlottesville, Virginia
ABSTRACT
Experience with the Cummings U-nephrostomy tube for more than 3 years in more than 30 cases has been favorable. Replacement in patients requiring long-term diversion has been necessary every 3 to 4 months because of ingrowth of tissue into the mushroom, causing an obstruction. Insertion of the new Cummings catheter by the technique outlined has been easy and free of complications. Nephrostomy drainage of the upper urinary tracts is used as a temporary and a permanent form of urinary diversion. Foley catheters have not proved satisfactory for this procedure because the balloon prevents adequate drainage owing to obstruction to the calices and renal pelvis. Mushroom catheters provide good drainage but may be dislodged accidentally and are difficult to replace. On the other hand, the U-tube nephrostomy is easy to replace and difficult to remove accidentally. 1- 6 A disadvantage of the U-tube is that if 1 limb is moved accidentally only a few centimeters the urine may drain outside the kidney causing a perinephric abscess (fig. 1).
U (fig. 2). The Cummings catheter has the additional advantage that either or both exiting tubes can be used for drainage. REPLACEMENT TECHNIQUE
Replacement of the Cummings catheter takes a little forethought and planning. Suture material, a Robinson catheter and a ruler are necessary. Since 1 limb of the catheter is much larger than the other the new catheter cannot be sewn simply to the old one and pulled through, as with the usual U-tubes made from ordinary tubing. The Robinson catheter is sewn to the small exiting tube of the Cummings catheter. The large
Fm. 1. A, normal placement of U-nephrostomy tube. B, slight displacement of tube with resultant spillage of urine and bacteria outside kidney in perinephric space.
exiting Cummings catheter is withdrawn until the Cummings catheter is removed completely and a portion of the Robinson catheter is pulled through. Then the suture between the small tube of the old Cummings catheter and Robinson catheter is cut and the small end of the new Cummings catheter is sewn to the same end of the Robinson catheter as the previous Cummings catheter. The Cummings catheter is then advanced into place by pulling on the Robinson catheter until the small end of the Cummings catheter exits (fig. 2). The mushroom portion is advanced into position in the renal pelvis by gently tugging on the small end of the Cummings catheter. When the mushroom portion of the catheter enters the renal Accepted for publication September 24, 1976. * American Cystoscope Makers, Inc., 300 Stillwater Ave., Stam- pelvis one usually feels a "pop". By measurement oflengths of the old tubing exiting one can confirm proper placement. ford, Connecticut 06902. 641
To eliminate this problem the Cummings catheter* has been used for more than 3 years in our institution for loop nephrostomy. The Cummings catheter is a mushroom catheter with a tail extending from the tip of the mushroom. These catheters were designed for use after pyeloplasties to provide renal drainage by a nephrostomy tube and a ureteral stent. The mushroom portion of the catheter is placed in a lower calix or renal pelvis and the distal portion of that tube exits from the parenchyma at the lower pole. The smaller tube at the other end either exits from the upper calix or renal pelvis to form the
-642
GILLENWATER
Fm. 2. A, placement of Cummings nephrostomy tube with both limbs exiting from parenchyma. B, small limb exiting from renal pelvis. C and D, technique of replacement by sewing Robinson catheter to exiting tube.
Absolute verification of correct position can be obtained by instilling some contrast agent and taking an x-ray. REFERENCES
1. Boeminghaus, H.: Urologie: OperativeTherapie, Klinik, Indikation, 2nd ed. Munich: Werk-Verlag, Dr. Edmund Banaschewski, p. 59, 1954. 2. Tresidder, G. C.: Nephrostomy. Brit. J. Urol., 29: 130, 1957.
3. Comarr, A. E.: An improved U-tube catheter. J. Urol., 92: 78, 1964. 4. Comarr, A. E.: Experience with the U-tube for renal drainage among patients with spinal cord injury. J. Urol., 95: 741, 1966. 5. Weyrauch, H. M. and Rous, S. N.: U-tube nephrostomy. J. Urol., 97: 225, 1967. 6. Binder, C., Gonick, P. and Ciavarra, V.: Experience with silastic U-tube nephrostomy. J. Urol., 106: 499, 1971.
THE JOURNAL OF UROLOGY
Copyright © 1977 by The Williams & Wilkins Co.
LOOP NEPHROSTOMY WITH THE CUMMINGS CATHETER JAY Y. GILLENWATER From the Department of Urology, University of Virginia Medical Center, Charlottesville, Virginia
ABSTRACT
Experience with the Cummings U-nephrostomy tube for more than 3 years in more than 30 cases has been favorable. Replacement in patients requiring long-term diversion has been necessary every 3 to 4 months because of ingrowth of tissue into the mushroom, causing an obstruction. Insertion of the new Cummings catheter by the technique outlined has been easy and free of complications. Nephrostomy drainage of the upper urinary tracts is used as a temporary and a permanent form of urinary diversion. Foley catheters have not proved satisfactory for this procedure because the balloon prevents adequate drainage owing to obstruction to the calices and renal pelvis. Mushroom catheters provide good drainage but may be dislodged accidentally and are difficult to replace. On the other hand, the U-tube nephrostomy is easy to replace and difficult to remove accidentally. 1- 6 A disadvantage of the U-tube is that if 1 limb is moved accidentally only a few centimeters the urine may drain outside the kidney causing a perinephric abscess (fig. 1).
U (fig. 2). The Cummings catheter has the additional advantage that either or both exiting tubes can be used for drainage. REPLACEMENT TECHNIQUE
Replacement of the Cummings catheter takes a little forethought and planning. Suture material, a Robinson catheter and a ruler are necessary. Since 1 limb of the catheter is much larger than the other the new catheter cannot be sewn simply to the old one and pulled through, as with the usual U-tubes made from ordinary tubing. The Robinson catheter is sewn to the small exiting tube of the Cummings catheter. The large
Fm. 1. A, normal placement of U-nephrostomy tube. B, slight displacement of tube with resultant spillage of urine and bacteria outside kidney in perinephric space.
exiting Cummings catheter is withdrawn until the Cummings catheter is removed completely and a portion of the Robinson catheter is pulled through. Then the suture between the small tube of the old Cummings catheter and Robinson catheter is cut and the small end of the new Cummings catheter is sewn to the same end of the Robinson catheter as the previous Cummings catheter. The Cummings catheter is then advanced into place by pulling on the Robinson catheter until the small end of the Cummings catheter exits (fig. 2). The mushroom portion is advanced into position in the renal pelvis by gently tugging on the small end of the Cummings catheter. When the mushroom portion of the catheter enters the renal Accepted for publication September 24, 1976. * American Cystoscope Makers, Inc., 300 Stillwater Ave., Stam- pelvis one usually feels a "pop". By measurement oflengths of the old tubing exiting one can confirm proper placement. ford, Connecticut 06902. 641
To eliminate this problem the Cummings catheter* has been used for more than 3 years in our institution for loop nephrostomy. The Cummings catheter is a mushroom catheter with a tail extending from the tip of the mushroom. These catheters were designed for use after pyeloplasties to provide renal drainage by a nephrostomy tube and a ureteral stent. The mushroom portion of the catheter is placed in a lower calix or renal pelvis and the distal portion of that tube exits from the parenchyma at the lower pole. The smaller tube at the other end either exits from the upper calix or renal pelvis to form the
-642
GILLENWATER
Fm. 2. A, placement of Cummings nephrostomy tube with both limbs exiting from parenchyma. B, small limb exiting from renal pelvis. C and D, technique of replacement by sewing Robinson catheter to exiting tube.
Absolute verification of correct position can be obtained by instilling some contrast agent and taking an x-ray. REFERENCES
1. Boeminghaus, H.: Urologie: OperativeTherapie, Klinik, Indikation, 2nd ed. Munich: Werk-Verlag, Dr. Edmund Banaschewski, p. 59, 1954. 2. Tresidder, G. C.: Nephrostomy. Brit. J. Urol., 29: 130, 1957.
3. Comarr, A. E.: An improved U-tube catheter. J. Urol., 92: 78, 1964. 4. Comarr, A. E.: Experience with the U-tube for renal drainage among patients with spinal cord injury. J. Urol., 95: 741, 1966. 5. Weyrauch, H. M. and Rous, S. N.: U-tube nephrostomy. J. Urol., 97: 225, 1967. 6. Binder, C., Gonick, P. and Ciavarra, V.: Experience with silastic U-tube nephrostomy. J. Urol., 106: 499, 1971.