Nephrostomy

Definition

A nephrostomy is a surgical procedure by which a tube, stent, or catheter is inserted through the skin and into the kidney.

Purpose

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:

The ureter is blocked by a kidney stone.
The ureter is blocked by a tumor.
There is a hole in the ureter or bladder and urine is leaking into the body.
As a diagnostic procedure to assess kidney anatomy.
As a diagnostic procedure to assess kidney function.

Demographics

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.

Description

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.

Diagnosis/Preparation

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.

Aftercare

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.

Risks

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:

injury to surrounding organs, including bowel perforation, splenic injury, and liver injury
infection, leading to septicemia
significant loss of functioning kidney tissue (<1%)
delayed bleeding, or hemorrhage (<0.5%)
blocking of a kidney artery (<0.5%)

Normal results

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.

Morbidity and mortality rates

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).

Alternatives

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.

Resources

BOOKS

Rodman, J. S. and C. Seidman. No More Kidney Stones. New York: John Wiley & Sons, 1996.

PERIODICALS

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.

ORGANIZATIONS

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 .

OTHER

"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 #x003E; .

Tish Davidson, AM
Monique Laberge, PhD

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

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.

QUESTIONS TO ASK THE DOCTOR

Why am I having a nephrostomy?
How do I prepare for surgery?
How long will I have to stay in the hospital?
How long do you expect the nephrostomy tube to stay in?
How much help will I need in caring for the nephrostomy tube?

User Contributions:

Jacqueline Orvis

Feb 8, 2006 @ 2:14 pm

Just wanted to add a comment on the reasons for having nephrostomy tube inserted. I am 27 weeks pregnant and had a tube placed about a week ago. Due to the pregnancy and risk to the baby, we were unable to determine if I had a kidney stone, or if the weight of the baby growing is blocking my right ureter. I subsequently developed marked hydronephrosis on my right kidney. Due to the pregnancy, I was unable to have a full x-ray, or IVP to check for a stone. I have been told by several people in the medical profession that the need for nephrostomy tubes during pregnancy is increasing. I just thought maybe a little information to add to your article would be helpful to pregnant women that have to have a nephro tube. Thank-you.

Linda Gibson

Feb 9, 2006 @ 10:10 am

I have a permanet nehprostomy tube due to a tumor pressing on my ureter. The tumor was radiated but left a scar on my ureter and the doctor has said there is no way to repair/replace the ureter or even put back a stent I had. The kidney is fully functioning and has no cancer. Has any one had this issue but were able to get rid of the nephrostomy tube.

amelia mccardle

Apr 30, 2006 @ 4:04 am

95 year old male with prostate, bladder. liver and lung cancers plus
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?

angelica

Mar 28, 2007 @ 7:19 pm

thanks for this article i learned more about neprostomy tube..............

Katlyn Davis

Apr 17, 2008 @ 12:12 pm

I am 29 year old female, currently 30 weeks pregnant. I had to have a tube placed at 19 weeks due to a 1 cm stone blocking my left ureter and hydronephrosis. They will not remove tube until 6 weeks after I deliver. I have had numerous problems with my tube, including a bacterial infection in that kidney that I ended up in the hosptial on 2 different antibiotics for weeks. The tube got completely blocked at one point and was completely encrusted after a few weeks from initial placement. Before it is all said and done I will have had at least 4-5 tubes put in and taken out due to the problems I have experienced in a 6 month time period.

Ajit Rai

Jun 17, 2008 @ 12:00 am

I am from Nepal. Six days ago, I had a nephrostomy tube place at the upper part of my right ureter from where a stone was removed through the MPCNL. The doctor told me that this tube will be removed after four weeks. The problem I have now is that I feel pain inside my body( probably at the upper part of my right ureter where there was a stone). Is it a sign of urinary tract infection. I would be grateful if you answer my question.

Nicole

Jun 19, 2008 @ 5:17 pm

I had a nephrostomy tube placed at 6 months of pregnancy due to an 8mm kidney stone and hydronephrosis. The tube was supposed to be replaced 3 weeks later but became stuck. A new tract had to be made for a bigger tube. Now I am expected to get it replaced every 2 weeks until the baby is born. I have no history of kidney stones or problems in my family. Ladies be careful not to go too long before tube changes. Pregnant women need it changed much more frequently or it will become clogged and stuck.

Nicole

Jul 29, 2008 @ 9:09 am

As an update to my June 19th, 2008 posting: My tube now needs to be changed every week and the doctor still has trouble getting the wire through the tube. I'm now 36 weeks pregnant. I have 3 more tube changes scheduled and then will have a c section. So during a 15 week period I will have experienced 2 different tracts put into my kidney and 9 tube changes. A few days after the c section I will have the kidney stone removed. Hopefully the tube will then be removed and I'll have a stent put in for a few days.

sheila

Sep 16, 2008 @ 1:01 am

I had a nephrostomy placed on a Friday morning, the radiologist forgot to attach to a bag, Friday night I was in double over pain, my doctor wrote for pain medicine, on saturday I was running a fever and doubled over in pain, my doctor said to go to the ER and he instructed them to load me up on pain medicine, on Sunday I sit down to use the restroom, still in major pain, still with fever and urine pours out my side. My body was infected for three days with urine, fortunate not to have become septic. Now I am having my kidney removed due to excessive daily pain, stones were removed but scarring and damage has left me in chronic pain.

texasdoe

Oct 27, 2008 @ 9:09 am

My mother passed away Sept 23 after a long bout with cervical cancer. She was 79 yrs old. Type II diabetic. But it wasnt the cancer that killed her. Before she was finally diagnosed her kidney Dr diagnosed some stones in her Left ureter and she underwent surgery 3 times to have it totally removed finally. After which she had a MRI to make sure all was good. At that time the MRI showed her cancer growing and spreading to other organs, Colon, Bladder, abdominal cavity. She underwent one chemo treatment which blew out her left ureter which had just had surgery 3 months before. Even though tests showed her Right kidney, ureter and bladder would still be ok, why the doctor recommended double neph, we will never understand. Then she had nephrostomy done on both kidneys. After that she never got out of bed or went out of the house. She slowly went downhill from there. Her legs became lathargic becasue she lost so much muscle mass. Soon she was in diapers and full hospice care for kidneys mind you. My mother wasnt dying of her cancer , it was because her kidneys had failed her through all these attempts to FIX the problem as her doctor kept saying. "This will fix the problem", she kept saying. I think since it was on her Left side that she should have had her left kidney removed only. Instead of having both her kidneys bagged as she called it. I would recommend that if you are undgoing same circumstances to consider a kidney removal, especially if the ureter is not working to drain to the bladder, instead of continuing with the nephrostomy of both. While she was in the nursing homes, she fell out of bed and her Left tube came out, then during a transfer from her wheel chair to her bed it happened again, we moved her to another nursing home and it happened there too, then she was dehydrated so bad she was kept at the hospital for the rest of her life. From February to October is all it took with her infections getting worse and worse because of bad care for her. We live to trust the experts and lived to see our mother suffer tremendously because of their unprofessionalism in her care. I will never allow myself to get that unhealthy. Check yourselves ladies and gents. Don't die because you didn't have complete physicals annually. Love yourself and take care of yourself and family. Get informed before making these decisions. And by that I mean 3 -4 opinions if necessary.

David

Dec 4, 2008 @ 4:16 pm

My best friend had a nephrostomy today. He's 55 and has been living with kidney stones most of his life. The pain had gotten worse lately and he was admitted and treated for it this morning. I had no idea that nephrostomy was such a risky and complicated procedure. And because we currently live in different countries, I don't know how he's doing. Reading the risks involved makes me feel awful. Even the less-than-1% mortality rate scares me. I feel horrified right now. My heart goes out to everyone who posted comments here, I feel your pain.

Manfred

Jan 6, 2009 @ 3:15 pm

In August of 2008 a cat scan showed a 7mm stone in my left kidney.
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.

Tina Cooper

Feb 1, 2009 @ 1:01 am

I had my first tubes put in 3 months ago with the first change last Monday, 1/25/09. Where do I buy back-ups of urine collection bags and velcro so I may shower? I have terrible insurance and lost the feeling and control in my left arm and hand after I went into renal failure.
Hey, still better than dialysis.

Megan

Feb 13, 2009 @ 3:15 pm

I am 24 weeks pregnant and 18 years of age. I got bi-lateral urethral stents put in a week ago, and then developed MRSA in my urine for whatever reason. Due to the MRSA being in my bladder i have decided to get the nephrostomy done so that the risk of the MRSA going up into my kidney would be at a lesser risk, so it it safer for me and my unborn son. I would just like to know if anyone has any advice for me and/or would like to share their experience. i am very scared about this whole thing and i just would like everything to turn out alright. Any advice???

terri

Mar 16, 2009 @ 10:10 am

my husband has a nephrostomy tube after his surgeon cut the left ureter during pelvic surgery. there are several corrective sugeries to reconnect the ureter to the bladder even to make a new ureter from a piece of intestines. these tpe of surgeries usually have high failure rates an it takes more surgery to try an get it right. my husband is in limbo right now an is weary of any tpe of surgery.

Cindy Findlow

Jul 5, 2009 @ 11:11 am

My mother has a nephrostomy tube due to a kidney stone and would like to find out if there is any way she can resume swimming. ie: waterproof suit, disconecting bag temporarily. Ha anyone done this?
Thanks

Pauline

Jul 13, 2009 @ 10:22 pm

My mother will have a nephrostomy catheter due to a UV fistula in one or two weeks. She got a TOT for urinary incontinence since last June.However, it was failed then she had TOT again by same urologist last Dec. Sorryfully,there were a hole in the ureter,causing urine to leak which lead to her another fistulectomy last Feb. The result was not positive. She has been staying a foley cathter for reducing the volume of urinary leaking to recover a UV fistula since then. Finally, her doctor decided to have a nephrostomy. Only one kidney of her is functiong which make me wondering how she would be after that. now.

suzanne

Jul 18, 2009 @ 12:12 pm

My mom has a tube because of bladder cancer but the area at insertion site leaks constantly with no solution to be found...also tube connections leak...does anyone else have this problem...she is 82 and totally frustrated but has no good choice in this matter.
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

Mrs. Taylor

Jul 27, 2009 @ 8:08 am

MY HUSBAND JUST HAD A KIDNEY ABOUT TWO WEEKS AGO AND NOW HE IS HAVING A NEPHROSTOMY. I AM WONDERING HOW SORE WILL HE BE AND HOW LONG WILL HE HAVE IT?

Lisa

Aug 4, 2009 @ 5:05 am

My Mum is 70 years old and had to have an operation due to a growth that was nothing we needed to worry about but the doctor said it was of considerable size and should be removed - during this operation her ureter tube was cut but this was not detected. A few days later she developed an infection in her blood and her kidney had become septic. She had an emergency procedure to drain her kidney and to place a stint to resolve the issue in her kidney (at this point the leak still was not detected) she was so ill and had serious complications during this procedure which resulted in her needing to stay in I.C.U. because she was seriously ill. Eventually she was allowed home to stay with me and I noticed she was leaking. Only a week after leaving hospital I took her to her first outpatients appointment and only at this point did the consultant inform us that she had also contracted e-coli while in the hospital and the cause, reason or result on her health was never explained. I informed the consultant that my mum was in considerable pain, she was examined and she was admitted again. She had to undergo a further procedure to insert a neph tube and it was to be a temporary solution - that was December 08 - she has had it changed once and has had numerous dye scans and x-rays which are very painful to determine the status of this tube - she had to have a further operation to repair and replace part of her ureter as her kidney was working normal but she was still leaking - they said they where pleased with this procedure but needed to maintain the neph. tube as a precaution - she had a further dye scan 3 weeks ago which has detected another leak so she still has the neph. tube and is being made to wait again and see if the leak repairs itself but the neph. tube has now become infected and has stop working altogether, she has informed the urology dept but they seem to have no problem with this - it is now Aug 09 and there is no definite closure to this whatsoever - my mother is house bound, seriously depressed, seems to have given up and become almost child like as she promises me she has been drinking water when I ask her if she has had fluids that day. I think it is a huge decision to opt for this procedure and I believe doctors may on occasions use it as a method of putting of until tomorrow what they should be doing today - I know everyone’s circumstances are different and this procedure may be appropriate in some cases but I would urge anyone who has been advised this is the way forward to ensure their doctor has given them a definite date as to when they will have this removed as my mum has been put of so many times she is now extremely depressed which is contributing to her declining health and a further reason for the doctors to postpone correction as she is not prepared for it mentally. All my mum wants is to have her life back because although she is 70 she was quite active and enjoying her senior years until this all came about. Read up on this on different sites to ensure you are aware of the exact details, after care and complications that can arise.

Ashley

Oct 2, 2009 @ 4:16 pm

I am 23 weeks pregnant and just had a tube put in right kidney due to a 8 mm stone. I am supposed to get it changed every three weeks. Do i change the bandage myself in between that time and when i shower should i cover the bandage with a bag of some sort?

wendy

Dec 29, 2009 @ 3:15 pm

i am a 35 yr old woman I had nephrostomy tubes put in due to complications in surgery...I was diagnosed with stage 1a cervical cancer and had a radical hystorectomy with lymphnode removal. All the cancer was removed during surgery but both of my ureters were severly damaged. so i have tubes in both kidneys. I am scheduled for surgery next month to reconstruct my ureters. they are going to be taking part of my small intestines for the reconstruction.

Gonzalez

Mar 23, 2010 @ 6:18 pm

Hi Linda Gibson,

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?

shannon

May 10, 2010 @ 8:20 pm

had right flank pain for years. did have a small stone, so they thought. after lithotripsy x3 & hospitalized for complications of that i was still undiagnosed and stillthe stone was the same. after a year and a new urologist. the 4th one diagnosed me w a calyceal diverticulm w a stone. after a stent placed in the neck of the diverticulum was unsuccessful i now have a nephrostomy tube. my kidney pain is gone! my severe pain at my incision site is horrible but worth it. get different opinions not all drs are equal

Ian Souter

Jun 16, 2010 @ 8:08 am

whats the likelyhood of problems with nephrostomy tubes and bags during flying

norval willnot

Jul 23, 2010 @ 1:13 pm

I HAD A NEPHROSTOMY OP 2 WEEKS BUT AM STILL SUFFERING FROM ACUTE NAUSEA - HAS ANYONE ELSE HAD THIS PROBLEM?

Dina

Jul 27, 2010 @ 10:10 am

I had a nephrostomy tube put in this past Saturday due to my ureter being cut during a hysterctomy in May. I'm having numbing sensation on both arms, I have sharp pains in my right kidney and the dr said I can go back to work this week. How long was it before some of you were able to go back to work?

Savannah

Aug 26, 2010 @ 4:16 pm

My dad has had a nephrostomy on the monday just gone. he has a kidney stone blocking his urine from coming out. His kidney stone is over 1cm big and he has been in alot of pain. he has been sent home from the hospital today with the tube still in and will have to go back to the hospital too have the stone removed in a week or so (as soon as his kidney infection has gone) Does any one know how they take the tube out and will he have to have stitches on his kidney when the tube comes out!? thankyou for any help.

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