Kidneys & urinary tract

Dr Marios Agathangelou performs urologic (kidney and urinary-tract) interventions in Nicosia and Limassol, Cyprus — covered by GESY, €0 for GESY beneficiaries. Urologic interventions relieve obstruction and protect kidney function from within: nephrostomy tubes drain a blocked kidney, ureteral stents restore flow to the bladder, and angioplasty reopens narrowed renal arteries.

Cysts are drained and treated with sclerotherapy, stones are managed, and urinary fistulas are addressed — each through a needle or catheter, under local anaesthesia, often as an outpatient procedure.

Kidney function preserved Local anaesthesia Often outpatient Relief of obstruction

The procedure is fully covered by GESY. It is done as an inpatient admission, and that admission includes the treatment — you pay nothing for the procedure.

Separately, the outpatient visit — the initial assessment, where it is decided whether the treatment suits you — may carry a small co-payment, usually €0–10, as any specialist visit within GESY does.

The co-payment is per activity, and it stops once your total co-payments for the year reach €150 — past that you pay nothing. Some categories of beneficiary have different limits.

Both need a valid referral, from your personal doctor or from a specialist.

Outside GESY, or with private insurance? We provide the documentation your insurer asks for, and a clear cost estimate at your consultation, before you decide anything.

An obstructed kidney with infection is an emergency. Fever and shivering together with loin pain, on a background of a stone or a narrowing, need the obstruction relieved promptly — not an appointment next week. In that situation timing matters more than the method.

An obstructed kidney is not a simple situation when infection is present as well.

Without infection, the problem is pressure. Urine that cannot get out presses on the kidney tissue and starves it of blood; and the more time passes, the larger the part of its function that is lost for good.

With infection, though, the clock runs differently. In severe cases, if the kidney is not drained, mortality reaches as high as one patient in five.

And the delay is measured in hours, not weeks. In an analysis of 311,100 hospital admissions in the United States for an obstructing stone with infection, patients drained from the second day onwards were about a third more likely to die. Across those admissions, though, deaths were few; the delay decides the extreme cases.

Not every dilated kidney needs draining, though. Hydronephrosis on its own is not an indication: pregnancy, diuretics, taking in a great deal of fluid, or reflux of urine from the bladder give the same picture on ultrasound with no obstruction that threatens the kidney.

There is also the reverse. In advanced cancer, where active treatment has stopped and the obstruction is one-sided, is not painful and has not become infected, the choice to leave the tube out is a reasonable one — an external urine bag carries its own cost in daily life.

Two things make decompression more urgent: when the kidney that has blocked is the only one working, and when it is a transplant. There is no second kidney to cover the loss while we wait.

Which of all these pictures is yours is not something a general description can say; your imaging and your blood tests show it. We will tell you which it is and what it means, before anything is done.

A nephrostomy and a ureteric stent do the same thing by two different routes: they unblock the kidney. They do not remove the stone, resolve the narrowing, or treat the tumour that is pressing on it. They are the step that protects the kidney so the definitive treatment can follow, and that is planned with the urologist.

Which of the two is better has not been settled by the literature; both are recommended, and the choice depends on the cause, the patient's condition and what comes next.

For the great majority the procedure has no complications. A little blood in the urine for a day or two and soreness at the puncture site are expected and settle by themselves.

The serious risk is septic shock at the moment of drainage. It concerns those who arrive with a kidney already infected and blocked: about one in twelve develops it at that very moment. That is why the drainage is done somewhere that can deal with it from the first minute.

The puncture is not the same in every kidney. When the collecting system is not dilated the target is small, and complications overall are six times more frequent than in a dilated kidney. That shows on the imaging beforehand, not during the procedure.

Less often: bleeding from a branch of the renal artery — which is why any blood in the urine that persists beyond three days is investigated.

And if the ureter cannot be crossed at the first attempt? It happens, particularly where the obstruction is long-standing and the ureter has become wide and tortuous. We then leave the nephrostomy to decompress for two or three days; the swelling of the lining subsides and the second attempt usually gets through.

The real price is not some complication; it is the upkeep. A stent is exchanged to a plan every four to six months and a nephrostomy tube, at first, every six to eight weeks — salts settle on them over time and they block.

No stent lasts for ever, and the forgotten stent is a recognised problem — which is why every patient with a stent is meant to go on a follow-up list, with a date for the next exchange.

What the patient feels differently in each case is the bladder. After a stent there is more blood in the urine and more burning than after a nephrostomy; the nephrostomy's price is the bag.

Which of the two suits you we decide together with the urologist, on the basis of what comes next. You will hear both sides, not only the one we recommend.

Clinical statements on this page follow the CIRSE Standards of Practice on nephrostomy and ureteric stent placement, published comparisons of nephrostomy and ureteric stenting, a national analysis of the timing of decompression in obstructing stones with infection, and the SIR quality improvement guidelines for percutaneous nephrostomy. They describe these procedures in general; they are not advice about your case.

BOOK A CONSULTATION +357 96 973434