A nephrostomy is a surgical procedure by which a tube, stent, or catheter is inserted through the skin and into the kidney.
The ureter is the fibromuscular tube that carries urine from the kidney to the bladder. When this tube is blocked, urine backs up into the kidney. Serious, irreversible kidney damage can occur because of this backflow of urine. Infection is also a common consequence in this stagnant urine.
Nephrostomy is performed in several different circumstances:
For unknown reasons, the number of people in the United States with kidney and ureter stones has been increasing over the past 20 years. White Americans are more prone to develop kidney stones than African Americans. Stones occur more frequently in men. The condition strikes most typically between the ages of 20 and 40. Once a person gets more than one stone, others are likely to develop.
Upper tract tumors develop in the renal pelvis (tissue in the kidneys that collects urine) and in the ureters. These cancers account for less than 1% of cancers of the reproductive and urinary systems. Upper tract tumors are often associated with bladder cancer.
First, the patient is given an anesthetic to numb the area where the catheter will be inserted. The doctor then inserts a needle into the kidney. There are several imaging technologies such as ultrasound and computed tomography (CT) that are used to help the doctor guide the needle into the correct place.
Next, a fine guide wire follows the needle. The catheter, which is about the same diameter as IV (intravenous) tubing, follows the guide wire to its proper location. The catheter is then connected to a bag outside the body that collects the urine. The catheter and bag are secured so that the catheter will not pull out. The procedure usually takes one to two hours.
Either the day before or the day of the nephrostomy, blood samples are taken. Other diagnostic tests done before the procedure may vary, depending on why the nephrostomy is being done, but the patient may have a CT scan or ultrasound to help the treating physician locate the blockage.
Patients should not eat for eight hours before a nephrostomy. On the day of the procedure, the patient will have an IV line placed in a vein in the arm. Through this line, the patient will receive antibiotics to prevent infection, medication for pain, and fluids. The IV line will remain in place after the procedure for at least several hours, and often longer.
People preparing for a nephrostomy should review with their doctor all the medications they are taking. People taking anticoagulants (blood thinners such as Coumadin) may need to stop their medication. People taking metformin (Glucophage) may need to stop taking the medication for several days before and after nephrostomy. Diabetics should discuss modifying their insulin dose because fasting is required before the procedure.
Outpatients are usually expected to stay in the clinic or hospital for eight to 12 hours after the procedure to make sure the nephrostomy tube is functioning properly. They should plan to have someone drive them home and stay with them for at least the first 24 hours after the procedure. Inpatients may stay in the hospital several days. Generally, people feel sore where the catheter is inserted for about a week to 10 days.
Care of the nephrostomy tube is important. It is located on the patient's back, so it may be necessary to have someone help with its care. The nephrostomy tube should be kept dry and protected from water when taking showers. The skin around it should be kept clean, and the dressing over the area changed frequently. It is the main part of the urine drainage system, and it should be treated very carefully to prevent bacteria and other germs from entering the system. If any germs get into the tubing, they can easily cause a kidney infection. The drainage bag should not be allowed to drag on the floor. If the bag should accidentally be cut or begin to leak, it must be changed immediately. It is not recommended to place the drainage bag in a plastic bag if it leaks.
A nephrostomy is an established and generally safe procedure. As with all operations, there is always a risk of allergic reaction to anesthesia, bleeding, and infection.
Bruising at the catheter insertion site occurs in about half of people who have a nephrostomy. This is a minor complication. Major complications include the following:
In a successful nephrostomy, the catheter is inserted, and urine drains into the collection bag. How long the catheter stays in place depends on the reason for its insertion. In people with pelvic cancer or bladder cancer where the ureter is blocked by a tumor, the catheter will stay in place until the tumor is surgically removed. If the cancer is inoperable, the catheter may have to stay in place for the rest of the patient's life.
The mortality rate of nephrostomies is of the order of less than 0.05% and the incidence of the specific complications listed above ranges between less than 0.05% (hemorrhage, kidney arterial blocking, and loss of kidney tissue) to less than 1% (injury to surrounding organs and septicemia).
In the treatment of ureter stones, extracorporeal shock wave lithotripsy (ESWL) has been most widely performed and has become the preferred treatment for this condition. ESWL is a new technique that offers an alternative to surgery for patients with kidney or ureter stones. ESWL works by pulverizing the stones into sand-like particles that can be excreted with little or no pain. This is achieved by the ESWL procedure approximately 90% of the time. The shock waves are a form of high-energy pressure that can travel in air or water. When generated outside the body, they pass through the tissues of the body without damaging them, but can destroy a stone inside a kidney or urethra. The shock waves pass through both without injury. A stone has a greater density and, when the shock wave hits it, the waves scatter and break it up.
Rodman, J. S. and C. Seidman. No More Kidney Stones. New York: John Wiley & Sons, 1996.
Cozens, N. J. "How Should We Deliver an Out of Hours Nephrostomy Service?" Clinical Radiology 58 (May 2003): 410.
Dyer, R. B., J. D. Regan, P. V. Kavanagh, E. G. Khatod, M. Y. Chen, and R. J. Zagoria. "Percutaneous Nephrostomy with Extensions of the Technique: Step by Step." Radiographics 22 (May–June 2002): 503–524.
Koral, K., M. C. Saker, F. P. Morello, C. K. Rigsby, and J. S. Donaldson. "Conventional versus Modified Technique for Percutaneous Nephrostomy in Newborns and Young Infants." Journal of Vascular and Interventional Radiology 14 (January 2003): 113–116.
Little, B., K. J. Ho, S. Gawley, and M. Young. "Use of Nephrostomy Tubes in Ureteric Obstruction from Incurable Malignancy." International Journal of Clinical Practice 57 (April 2003): 180–0181.
American Cancer Society. National Headquarters. 1599 Clifton Road NE, Atlanta, GA 30329. (800) ACS-2345. http://www.cancer.org .
American College of Radiology (ACR). 1891 Preston White Drive, Reston, VA 20191-4397. (800) 227-5463. http://www.acr.org .
American Urological Association (AUA). 1120 North Charles Street, Baltimore, MD 21201. (410) 727-1100. http://www.auanet.org .
United Ostomy Association (UOA). 19772 MacArthur Blvd., #200, Irvine, CA 92612-2405. (800) 826-0826. http://www.uoa.org .
"Extracorporeal Shock Wave Lithotripsy (ESWL)." Family Practice Notebook May 28, 2003 [cited July 7, 2003]. http://www.fpnotebook.com/SUR46.htm .
"Nephrostomy." Mid-South Imaging and Therapeutics [cited July 7, 2003]. http://www.msit.com .
"Percutaneous Nephrostomy." WFUSM Division of Radiologic Sciences. May 8, 2003 [cited July 7, 2003]. http://www.rad.bgsm.edu/patienteduc/percutaneous_nephrostomy.htm .
Tish Davidson, AM
Monique Laberge, PhD
A nephrostomy is performed by an interventional radiologist or urologist with special training in the procedure. It can be done either on an inpatient or outpatient basis, depending on why it is required. For most cancer patients, nephrostomy is an inpatient procedure. Specially trained nurses called wound, ostomy continence nurses (WOCN) are commonly available for consultation in most major medical centers to assist patients.
a 5.5cms abdominal aneurysm, also hematuria underwent a nephrostomy 04/26/06. What would the prognosis
be? Would removal of inserted catheters eventually be possible?
I was waiting to get the shock wave treatment and told to drink a lot. After a week I had increased pain in my left lower back and since I'm on opoids for cronic lower back pain, I was first not sure that it was my kidney. I went in to the emergency room of our lokal hospital but not taken serious. I argued with the nurses until I could see a doctor. At first he was also belittleing the situation , but checked my urine. Next followed a cat scan and it was determined, that the stone had moved into the ureta and was stuck there. I was on emergency stand by to have the stone moved back into the kidney and to have a stent inserted so the kidney could drain. During that procedure the Doctor inserted the stent and also broke the stone and removed most of it. Few weeks later the stent was removed and I had a follow up appointment in December. An ultrasound the end of November was also done. I had more pain and very high blood pressure. Could not stand the pain and went to emergency again. A cat scan showed that the kidney could not drain and was swollen. A week later the urologist tried to open the ureta but was not successful and the next day I got my nephrostomy tube. Now since Christmas I'm in limbo and hope that the kidney can still be saved.
Hey, still better than dialysis.
Thanks
Any info would be of great help to us...doc has said it is a "minor inconvenience" compared to what she had been experiencing before with no bladder control at all.
Please write me if you have anything to add to her situation.
thank you
My father goa a nephrostomy tube inserted for the same reason. He is yet to start chemo on 03-26-10, and radiation. What questions should we be asking?
I have been told my Nephrostomy needs to stay for another 4 weeks i am just wondering is the removal procedure painful, uncomfortable or do you just not feel it at all?
And receive immune suppressing meds. Still have feel a slight burning feeling after 6 months. Also notice bubbles in urine.
8 weeks later I still don't know when the nephrostomy tube will be removed. The kidney stone still remains where it was to begin with. I feel lost and have very little faith on the local health care. Every day I experience extreme pain. I feel for all those people that have this problem..
still have cancer cells but they can not find out where they are coming from. ...help if you have any ideas...thanks
Thanks.
I made for my dear husband, could help so many others. I'd like to submit to this forum,so all could see there is something out there to make the patient more comfortable. My product is mention on this page.I've sold belts across the USA and in other countries. The testimonies I recieve bring tears to my eyes, because I know how people suffer with these types of obstructive catastrophic processes.Look me up on the internet.
Vicki,
why is this? i am very worried.
To Shana- our husbands are in the same situation- having one working kidney and one with the tube- with metastatic colon cancer- My hubby had his colon resected almost 5 years ago- has had 3 other tumors removed surgically (they were more on the inside of his belly- not in the colon) he has done oral chemo on and off over the last 5 years-his numbers have gone up and down like a yo-yo and then our medical system has changed testing protocols for CEA and now we are in a real state of not understanding much (again) but it looks like his numbers are the highest they've been as of 3 weeks ago- he is so sick of being sick- we aren't giving up hope tho- we do have an appointment with the cancer center in Vancouver in 2 weeks to see if there isn't something that can be done to get rid of this tube and bag-
To Kelly- the best thing is dress to feel comfortable- loose clothing- hubby wears nice track pants with a leg back - and then he tucks the bottom into his sock- for his dressing we have a stat-loc mounted on a sticky butterfly looking patch- and then I use sterile gauze under the tube before it goes into the stat loc- and place another guaze over the tube - it is all held down with a large Tega-derm clear patch- and then we just tape the tube down in one more place on his hip. About 6 inches down the tube there is like a stop-cock thing that I wrap cotton or guaze around and tape it up so that it doesn't dig into his skin-
I hope the New Year was good to you all- and that it finds you in good health- this was so scary to start with and now that we have had to deal with it for a year it isn't- this site was very helpfull- thank-you-
If I can be of any help to anyone don't be afraid to email me and ask- there are no embarssing questions when it comes to your health! Even if you just need to hear that it's going to be ok, or that something is "normal" or if you are scared- I will try and help-
My issue is that I am constantly in the hospital for a severe kidney infection, even though I have been on antibotics for two years. I have a great urologist but I feel Im getting know where. My problem is that I had to have a hysto 6 yrs ago and I ended up in the hospital for 8 weeks and 5 surgeries later, because of infection and blood clots. After spending this Christmas in the hospital and away from my three beautiful children (Im a single Mom) I was told that I may loose my right kidney because it was swollen really bad, as well as all the tissue around it. I have had so many test ran and they show nothing is wrong. My dr said that there is no test that will show scar tissue. So both me and my doctor both feel like I have scar tissue that is blocking my ureter. Something HAS to be done to fix the problem because I'm not capable of being the best Mom I can be and the pain is unbearable. Everytime I have to "pee", I have to push extremely hard and most of the time I'm not even successful at being able to release any urine. I leave the restroom completely exausted and have a bad headache. I just had brain surgery 4 wks ago and Im scared that with me grunting to pee, that Im gonna mess up sumthing in my brain because I push so hard and I feel the pressure in my head.
What do you feel would work best for me? I really dont want a stint because I have friends with horror stories but I've never heard of a nephrectomy, urotersopy, nephrostomy, nor a neph tube. I had to miss my last urology appt because of my brain surgery but I'm excited to discuss these options with him. I would love for you to give me all your advise too. All of you have lived with this issue and my dr preforms the procedure but hasnt had to deal with this on a personal level. IM BEGGING FOR YOUR ADVISE SO PLEASE EMAIL ME. I ONLY HAVE A WEEK SO PLEASE REPLY QUICKLY! All of you will be in my prayers. God Bless You All!
In. the tube in my right kidney is uncomfortable and always tender.i don't have pain when i urinate just discomfort and tender pressure on the bladder. I make sure i drink plenty of water because i don't want any tops of urinary problems from drinking soda and stuff. Cranberry juice is good too. To Joanna, the hospital gave me extra drain bags, so if you ever go back ask your nurse for so extra bags. To Kelly, wear long maxi dresses hides everything well. God bless us all who ate going through this. Its hard and frustrating, i look forward to my permanent removal.
And affected the diaphragm 1 wk later she still having trouble breathing completely cuzz it hurts her in. Her shoulder n chest area( I shall repeat this occured following her tube removal. Drs is saying it will get better granted she has been dealing with pains since 8yrs old. PLEASE Advise. We live in n county San Diego.
Could you give me some advice to get her sprits up and that she can do the things she loves.She thinks she has lost all parts of life cause she says this is not living. Thank You so much , Cindy
My first stent was placed in October 2014 and failed by January 2015... That stent was removed and replaced and then failed again in May 2015 , so was removed and replaced again. The pain became unbearable by July 2015 but no surgeon would touch me as I was 28 weeks pregnant. My obstetrician was beyond concerned as I had started going into preterm labour due to the sever pain and constant infections caused by the stent and calcification. She was able to pull some strings and had a urologist remove my stent in August 2015 but he refused to put in a Nephrostomy tube as I was too high risk and not his patient. At that point I didn't care and just needed that stent out. His first attempt to pull it out and he backed off saying it was too stuck and he couldn't. I begged and cried for him to please try again and he did. I felt my kidney being pulled through my body, the pain had me screaming and in tears but it was out. The doctor and nurse both looked horrified at the sight of the stent that was just removed. The calcification build up had encrusted the tube so badly that it was not working and had nearly tripled the stent in size.
I ran to the bathroom immediately with a overwhelming urge to urinate finally. What I thought was going to feel amazing put me in even more pain and tears. I was left for 2 days to pee out the left behind debris and calcification build up. I could feel it shredding and blocking my insides as I bled more than I urinated just trying to pee them out. A nurse described it as passing between 50-70 sharpened kidney stones within a 3 day period. I thought my child and I were going to die. Finally I went back to emerg and was admitted. I was in surgery to have the Nephrostomy placed the next afternoon. So far so good with it. I cannot believe the relief I have down below. The discomfort and inconvenience caused by this tube is well worth it compared to those dreaded kidney stents! Needless to
Say this is the worst pregnancy every and I can't wait to
Finally have this baby, get my ureter repaired and have this tube out. I don't even Remember what having my own body is like anymore. I've been living with these foreign objects and a growing child for almost a year now and gone through hell. Almost there!!!
I contacted my Urological Surgeon Nov 11th and was told the tube needed flushed, to come into the office. They tried flushing the tube, but it didn't work. Was sent to another hospital for an Nephrostogram.
The Radiology Surgeon did the procedure with Contrast injected through the tube and said everything seems normal, but there appears to be a small piece of stone lodged in the tube. Was sent home.
The tube still isn't working, at all.
When the tube was placed, it was drilled into my head that if the tube stopped draining I needed to contact the Doctor A.S.A.P. because something was wrong. All the discharge papers stated if the tube stopped working to contact the Doctor A.S.A.P.
My tube stops working, I call the Doctor, and they seem to be treating it like it's no big deal, and nothing has been done.
I'm scared that I'm going to die now.
I have also lost control of my bladder so I'm peeing all the time and have to use pads. Will this get any better and go back to normal?
Any replies appreciated.
This wad put in after I developed sepsis after a surgeon burnt a joke in my uretha and it wasn't noticed.
I had a stent put in for 7 weeks and developed infections.
I have had sepsis
E-coli
Step-d
Combactapholis
C-diff
Providentia
Puerto mariliria
Spellings dodgy!
I'm due to have reconstructive surgery of the bladder
Yikes
This was put in after I developed sepsis after a surgeon burnt a hole in my uretha and it wasn't noticed.
I had a stent put in for 7 weeks and developed infections.
I have had sepsis
E-coli
Step-d
Combactapholis
C-diff
Providentia
Puerto mariliria
Spellings dodgy!
I'm due to have reconstructive surgery of the bladder
Yikes
Had to hav ureter stents put in and they helped for a couple of months but then had more kidney pain. Ended up putting in Neph tubes in . I have had them in for 9 months and had them exchanged 5 times since. This last Neph tube exchange Developed extreme bleeding in both Neph bags and peeing blood with a lot of blood clots. Then the next day my right abdomen and right leg has swollen up severely. Having abdomen and kidney pain. When I stand up and walk my right leg swells up to the point where I can’t take the pain. Has anyone else ever seen this before.
My doctors are not figuring this out
Thank you