When the Kidney Needs Another Way Out

A nephrostomy is a procedure that creates a temporary or sometimes longer-term drainage route from the kidney directly to the outside of the body.

A nephrostomy tube is usually placed by an interventional radiologist using imaging guidance. The purpose is to drain urine directly from the kidney when the normal pathway through the ureter is blocked.

Preparation: You usually lie on your stomach or slightly turned to one side. Your back is cleaned and covered with sterile drapes. An IV may be used for sedation, pain medicine, antibiotics, or fluids.

Numbing the area: Local anesthetic is injected into the skin and deeper tissues over the kidney. You may feel a brief burning or stinging sensation.

Finding the kidney: Ultrasound and often fluoroscopy/X-ray are used to locate the kidney and choose a safe path into the urine-collecting system.

Needle placement: A thin needle is passed through the skin into the kidney's collecting system. Most people feel pressure more than sharp pain. Contrast dye may be injected to show the renal pelvis and ureter.

Guidewire insertion: Once the needle is correctly positioned, a thin guidewire is passed into the kidney.

Tube placement: The tract is gently enlarged, and the nephrostomy catheter is advanced over the wire. The end of the tube usually curls inside the kidney so it stays in position.

Drainage begins: Urine flows through the tube into an external drainage bag. The tube is secured to the skin with a dressing and sometimes a small securing device or stitch.

During the procedure, you may feel pressure, pulling, pushing, or brief discomfort. With sedation, many patients are relaxed and remember little of the procedure. Afterward, the insertion site can feel sore or bruised for a day or two. A small amount of blood-tinged urine can sometimes occur initially.

After placement, care focuses on keeping the tube clean, secure, and draining freely. Keep the drainage bag below kidney level, avoid pulling or twisting the tubing, and empty the bag before it becomes overly full. Keep the dressing clean and dry and change it according to your clinical team's instructions. Some nephrostomy tubes require flushing with sterile saline, but only do this if your medical team specifically tells you to and teaches you how.

Contact your healthcare team promptly if the tube stops draining, becomes dislodged, urine begins leaking heavily around the tube, or you develop worsening pain, redness, swelling, foul-smelling drainage, significant bleeding, fever, or chills. Fever or chills with an obstructed kidney can represent a serious infection and needs urgent medical attention.

The nephrostomy may stay in place for days, weeks, or longer depending on why the urinary system is blocked. It can often be removed once the stone, tumor, narrowing, or other obstruction has been treated and urine can again travel safely from the kidney through the ureter to the bladder.