# CIRSE Standards of Practice on Nephrostomy and Ureteric Stent Placement and Exchange

## TL;DR

This paper provides standardized guidelines for performing nephrostomy and ureteric stent procedures to treat obstructive uropathy, aiming to prevent kidney damage and sepsis.

## Contribution

The paper introduces updated clinical practice standards for nephrostomy and ureteric stent placement and exchange based on recent evidence.

## Key findings

- Percutaneous nephrostomy is recommended for urgent decompression in infected obstructed kidneys.
- Antegrade ureteric stenting is frequently used to relieve obstruction after nephrostomy.
- The guidelines are based on a review of evidence from 2001 to 2025 and include relevant older sources where data remain current.

## Abstract

Obstructive uropathy is a very common pathology of the genitourinary system which, if untreated, leads to renal impairment, end-stage renal failure and death. Particularly in the case of acute obstructive uropathy, urgent decompression is necessary to prevent compression-mediated ischaemia of the renal parenchyma and the development of irreversible renal failure. Percutaneous nephrostomy is a well-established and relatively safe image-guided procedure used to obtain access to the renal collecting system and is the procedure of choice for the infected obstructed kidney, minimising the risk of septic shock and possible death. Subsequent internalisation via antegrade ureteric stenting is frequently employed to relieve obstruction at the level of the causative lesion.

CIRSE Standards of Practice documents recommend a reasonable approach to, and best practices for, performing procedures, in this instance, Nephrostomy and Ureteric Stent Placement and Exchange.

The writing group, established by the CIRSE Standards of Practice Committee, consisted of five clinicians with internationally recognised expertise in this topic, and one research assistant (I.I.). The writing group reviewed the existing literature, performing a pragmatic evidence search using PubMed to search for publications in English relating to human subjects from 2001 to 2025. Relevant older primary sources were included where the data have not been updated.

A document was produced, making recommendations for practice based on currently available evidence in a range of clinical scenarios.