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Nephrostomy

(Percutaneous Nephrostomy)

Pronounced: Purr-cue-TAY-knee-us Nef-RAW-stow-me
by Patricia Griffin Kellicker, BSN

Definition

A nephrostomy is a procedure in which a tube called a catheter is placed into the kidney. The catheter is guided into the kidney by a computed tomography (CT) scan or ultrasound.

Reasons for Procedure

A nephrostomy is done to drain urine from your kidney. This needs to be done when urine cannot come out as it normally does. Specific conditions that may cause this include:

  • Damage to the bladder
  • Blockage in the ureter, which is the tube that carries urine from the kidney to the bladder, due to:
    • Infection
    • Tumor
    • Kidney stone
    • Scar tissue
    • A condition that is present at birth

Kidney Stone

Copyright © Nucleus Medical Media, Inc.

A nephroscopy through a nephrostomy may also be used to look at the kidneys and ureters before other procedures are done, such as kidney stone removal. This may also help your doctor make a diagnosis.

Possible Complications    TOP

Complications are rare. But, no procedure is free of risk. If you are planning to have a nephrostomy, your doctor will review a list of possible complications, which may include:

  • Bleeding
  • Infection
  • Damage to nearby organs and tissue
  • Kidney function loss
  • Blood clots
  • Reaction to the anesthesia such as lightheadedness, low blood pressure, and wheezing
  • Pain

Factors that may increase the risk of complications include:

  • Smoking
  • Liver failure
  • Pregnancy
  • Use of blood thinners
  • Long-term illness

What to Expect    TOP

Prior to Procedure

  • At the appointment before the test:
    • Your doctor may do tests like a CT scan or ultrasound. You may also have blood and urine tests.
    • Questions your doctor may ask include: Are you pregnant? Do you have any allergies to contrast dye?
    • Questions you should ask your doctor include: How long will the catheter need to stay in place? What signs should I look for in case there is a problem with the catheter?
  • Arrange for a ride home from the hospital.
  • Do not eat or drink for eight hours before your procedure. If you are taking medicines, ask your doctor if you should take them the morning of your procedure with a sip of water.
  • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure like:
    • Anti-inflammatory drugs
    • Blood thinners

Anesthesia

You will receive a local anesthetic to numb the skin on your lower back. An IV will be placed. You will receive a sedative, pain medicine, and antibiotics through this IV.

Description of Procedure

A nephrostomy is usually done in an outpatient setting. You will not need to stay in the hospital overnight. Ultrasound or x-ray images will be used to locate your kidney and guide the doctor. A needle will be inserted through your skin and into your kidney. A contrast material will be injected through the needle to better view the kidney on the x-ray. The catheter will then be placed into your kidney. The catheter will come out of your skin and be attached to a collection bag. A dressing will be placed at the insertion site. Urine will drain from your kidney into the collection bag.

Immediately After Procedure

After the procedure, you will be monitored for 8-12 hours to make sure the catheter is draining urine. The urine may appear bloody at first. But, it will clear over time.

How Long Will It Take?

15-30 minutes

How Much Will It Hurt?

You may feel soreness at the insertion site for several days after your nephrostomy. Your doctor will give you medicine to help with the pain.

Post-procedure Care

At the Care Center

After the procedure, the staff may give you the following care to make you more comfortable and to help you recover:

  • Your collection bag will be checked to make sure the catheter is draining your kidney well.
  • You will be shown how to care for your catheter. You will be sent home with extra collection bags and dressing supplies.

You will be able to leave when your catheter is working and you are comfortable caring for it.

At Home

When you return home, do the following to help ensure a smooth recovery:

  • Ask someone to stay with you for the first 24 hours after the procedure.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Keep the insertion site and dressing dry. Protect it from getting wet when showering. You can use plastic wrap to cover it.
  • Do not let the collection bag get too full before emptying it.
  • Change your dressing every 2-3 days. If your dressing gets wet, loose, or dirty, change it. Always wash your hands before changing your dressing.
  • Be sure to follow your doctor’s instructions.

Call Your Doctor    TOP

After arriving home, contact your doctor if any of the following occurs:

  • Catheter problems:
    • Urine no longer drains
    • Catheter is bent or twisted
    • Leakage occurs around the catheter
  • Signs of infection, including fever or chills
  • Urine becomes cloudy, bloody, or smells bad
  • Sudden pain
  • Redness, swelling, increasing pain, a lot of bleeding, or any discharge from the incision site
  • Pain that you cannot control with the medicines you have been given

In case of an emergency, call for medical help right away.

RESOURCES:

Urology Care Foundation
http://www.urologyhealth.org
National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov
National Kidney Foundation
http://www.kidney.org

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca
The Kidney Foundation of Canada
http://www.kidney.ab.ca

References:

Percutaneous nephrostomy tube. University of Virginia Heath System website. Available at: http://www.medicin... . Updated March 11, 2004. Accessed May 9, 2013.
Practice guideline for the performance of percutaneous nephrostomy. American College of Radiology website. Available at: http://www.acr.org... . Revised 2011. Accessed May 9, 2013.
Professional Guide to Diseases . 9th ed. Ambler, PA: Lippincott Williams & Wilkins; 2009.
Skolarikos A , Alivizatos G , Papatsoris A , Constantinides K , Zerbas A , Deliveliotis C . Ultrasound-guided percutaneous nephrostomy performed by urologists: 10-year experience. Urology . 2006 Sep;68(3):495-9. Epub 2006 Sep 18.
Wen X , Gao X , Li X , Lu M , Cai Y , Qiu J , Xiao C . One-step percutaneous nephrostomy in patients with a history of open nephrolithotomy: comparison with the fascial dilator system. J Endourol . 2007 Nov;21(11):1281-5.
6/2/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.
Last reviewed May 2013 by Adrienne Carmack, MD; Michael Woods, MD
Last Updated: 5/9/2013