Background: This study evaluated the feasibility and success of advancing a guidewire alongside the nephrostomy tube instead of through it in patients undergoing endourological procedures who had nephrostomy tubes. Methods: 33 patients with nephrostomy tubes in place underwent endourological procedures over a 2-year period (2023–2025). Under fluoroscopic guidance, a guidewire was advanced alongside the nephrostomy tube, and success was defined by the wire reaching the renal pelvis or ureter. Outcomes were compared to the conventional technique of inserting the guidewire through the nephrostomy tube, and the influence of time since nephrostomy placement on success was assessed. Results: Guidewire passage alongside the nephrostomy tube succeeded in 27 of 33 cases (81.8%). Failures occurred in 6 cases (18.2%), mainly because of tortuous or calcified tracts requiring new access. The conventional through-tube approach succeeded in 32 of 33 cases (97%), but this difference was not statistically significant ( p = 0.10). Notably, the alongside approach achieved ureteral/bladder access in a higher proportion of cases than the through-tube method (48.4% vs 12.1%, p = 0.003). Longer time intervals between nephrostomy placement and the procedure were associated with increased success ( p = 0.002), with an optimal cutoff of ∼1.3 months identified. Conclusions: Guidewire passage alongside an existing nephrostomy tube proved to be a safe, effective, and feasible technique for establishing antegrade access. Performing the procedure more than ∼1.3 months after nephrostomy placement was associated with higher success, suggesting that a well-matured tract improves outcomes.
Bashi et al. (Fri,) studied this question.
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