Upper tract urokinase instillation for nephrostomy tube patency

PURPOSE: We describe a useful technique for declotting a nephrostomy tube blocked secondary to recurrent blood clot formation. MATERIALS AND METHODS: Urokinase was instilled into the nephrostomy tube in a patient with a solitary kidney obstructed by malignancy on 2 separate occasions for 30 minutes each followed by manual irrigation with normal saline. RESULTS: The nephrostomy tube and renal pelvis were successfully declotted, and we avoided a nephrostomy tube change or insertion of a second tube. The tumor was subsequently embolized to prevent further bleeding. CONCLUSIONS: Instillation of urokinase into a nephrostomy tube blocked by a blood clot may obviate repeat nephrostomy tube changes and is a useful addition to the urological armamentarium.