Computed tomographic evaluation and guided correction of malpositioned nephrostomy catheters

Background: To determine the utility of computed tomography (CT) in the detection and correction of malpositioned nephrostomy catheters after contrast spillage during nephrostograms. Methods: CT was performed in nine patients after an abnormal (contrast spillage) tube nephrostogram performed during or after nephrostomy tube placement. CT was used to locate the nephrostomy catheter position in relation to the renal collecting system. If possible, CT was also used for guidance and repositioning of the nephrostomy catheters into the intrarenal collecting system. Results: In all nine cases, CT was successful in detecting the position of the suspected malpositioned catheter. In seven of nine cases, CT demonstrated the catheter outside the renal collecting system and effectively helped reposition the catheters into the intrarenal collecting system. In one case, the malpositioned nephrostomy catheter was within the intraperitoneal cavity and required surgical correction. Another case required fluoroscopic-guided repositioning for the initial nephrostomy catheter, which was partly posterior to the kidney and partly within the kidney. The catheter in this latter case was successfully advanced over a guidewire into the collecting system. Conclusions: CT may be used to detect possible catheter malposition associated with nephrostomy tube placement. CT may also be used to successfully guide catheter repositioning in the renal collecting system. Received: 29 May 1998/Accepted: 20 July 1998