(Percutaneous Nephrostomy)
Definition
Definition
A nephrostomy is a procedure in which a tube called a catheter is placed into the kidney. A CT scan or ultrasound guides the catheter into the kidney.
Reasons for Procedure
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
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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
Possible Complications
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
- Pain
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
- Smoking
- Drinking
- Chronic disease such as diabetes or obesity
- The use of certain medications
Your risk of complications may also increase if you have:
- Liver failure
- Pregnancy
What to Expect
What to Expect
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 8 hours before your procedure. If you are taking medications, ask your doctor if you should take them the morning of your procedure with a sip of water.
- Talk to your doctor about your medications. You may be asked to stop taking some medicines up to 1 week before the procedure.
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 medication, 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. 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. You will be given medication 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.
During your stay, the hospital staff will take steps to reduce your chance of infection such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your incisions covered
There are also steps you can take to reduce your chances of infection such as:
- Washing your hands often and reminding visitors and healthcare providers to do the same
- Reminding your healthcare providers to wear gloves or masks
- Not allowing others to touch your incisions
At Home
When you return home, do the following to help ensure a smooth recovery:
- Do not let the collection bag get too full before emptying it.
- Be sure to follow your doctor’s instructions.
Call Your Doctor
Call Your Doctor
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 medications you have been given
In case of an emergency, call for emergency medical services right away.
RESOURCES:
National Kidney Foundation http://www.kidney.org
CANADIAN RESOURCES:
References:
http://www.medicine.virginia.edu/clinical/departments/radiology/divisions/angiography/angio-pted-nephrostomy-page
Updated March 11, 2004. Accessed January 12, 2015.
Practice guideline for the performance of percutaneous nephrostomy. American College of Radiology website. Available at:
http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Percutaneous_Nephrostomy.pdf
Updated 2014. Accessed January 12, 2015.
Skolarikos A , Alivizatos G , et al. Ultrasound-guided percutaneous nephrostomy performed by urologists: 10-year experience. Urology. 2006 Sep;68(3):495-499. Epub 2006 Sep 18.
Wen X , Gao X , et al. One-step percutaneous nephrostomy in patients with a history of open nephrolithotomy: comparison with the fascial dilator system. J Endourol. 2007 Nov;21(11):1281-1285.
6/2/2011 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
Mills E, Eyawo O, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.
Last Updated: 4/29/2014