Nephrostomy

This is a procedure in which a catheter is placed through your skin into your kidney to drain your urine. An interventional radiologist, who is specially trained, performs this procedure in the Radiology Department. The radiologist uses x-ray imaging to help guide the catheter into exactly the right place to drain your urine. This is done instead of surgery.

Why do I need a nephrostomy?
Blockage of the ureter is a common reason to need a nephrostomy. The kidney makes urine, which drains down the ureter from the kidney to the bladder. When your ureter is blocked, the urine backs up in your kidney. Signs of his are pain and fever, but some people experience no symptoms. The blocked ureter needs treatment because urine cannot drain out of the kidney and the kidney may stop working. The nephrostomy will give the urine a way to leave the kidney.

If a hole forms in the ureter or bladder, this allows urine to leak out in other areas of your body. This can cause pain and severe infection. A nephrostomy drainage can stop the leaking and help to heal the hole. You may also need a nephrostomy to prepare you for surgery or some other procedure on your kidney or ureter, such as the removal of a large kidney stone.

What do I do to prepare for the nephrostomy?
Inpatients: Your nurses and/or doctor will give you instructions.

Outpatients or those being admitted on the morning of procedure: Follow the instructions below:

  1. Do not eat any solid food after midnight before your procedure You may drink clear fluids and take your medications.
  2. If you are a diabetic and take insulin, ask your doctor about modifying your insulin dose for the day of your procedure. If you take the blood thinner Coumadin, you must tell your doctor so that it can be stopped the proper number of days in advance.
  3. Bring all your medications with you.

Everybody having a nephrostomy drainage will have blood tests done close to the day of the procedure. Outpatients will have lab tests drawn two hours before the scheduled time of your procedure. On the day of your procedure, an intravenous (IV) line will be placed in one of your veins and antibiotics will be given to you through it. The antibiotics help to prevent infection. The IV will be used to give you other medicines and fluids during the procedure. The IV will stay in place until the procedure is complete and until the radiologist and/or your doctor says to discontinue it.

What is a nephrostomy drainage like?
Before the procedure starts, you will be given pain medication through your IV. A local anesthetic will also be used to numb the skin and deeper tissues in the area of your back where the catheter will be placed.

There are three major steps to the procedure:

  1. Placement of a needle into the kidney
  2. Placement of a guide wire farther in the kidney
  3. Placement of the drainage catheter.

The procedure normally takes 1-2 hours.

What do i do after the procedure is over?
Inpatients: You will return to your room and be observed by your nurse to make sure you are all right. You will be informed when you can eat and drink and how long you need to stay in bed. Because everyone is different, it is not possible to say how many days you will need to stay in the hospital.

Outpatients: You may be asked to stay from 6-12 hours. The staff will observe you to be sure you are all right and do not develop symptoms such as fever.

You will be sore for 7-10 days after your catheter is inserted. The nephrostomy drainage catheter is about the same size, if not smaller, than IV tubing. This catheter will be connected to a drainage bag and your urine will drain out of your body and into the bag.

How long do i have to have the drainage catheter?
This depends on why you needed the catheter. If the catheter is placed to relieve blockage of your ureter, you will need it until the blockage no longer exists. Your ureter can be blocked by stones, infection, scar tissue or tumor. If your catheter is placed because you have a hole in your ureter, you will need it until the hole has healed. If your catheter was placed to prepare you for surgery, you will need it until after your surgery. Some patients need their nephrostomy drainage catheter for the rest of their lives. Your doctor will tell you how long you will probably need your nephrostomy drainage catheter.

Are there risks of a nephrostomy drainage?
The procedure is safe, but some complications may occur. The two most frequent are bleeding and infection. That is why you need to stay for awhile after the catheter is placed. A member of the interventional radiology team will discuss the risks with you in detail before the procedure starts.

How will I benefit from a nephrostomy drain?
In most cases, the only solution to these problems and symptoms was surgery. now with the urine draining out of the catheter, a hole in the ureter can heal and prevent serious infection. If your ureter is blocked, the drain will relieve your symptoms like pain, fever and chills. In some cases, the catheter can help your doctor eliminate the source of your blockage. If your ureter is blocked with stones, your doctor may be able to remove these through the tract which has already been made by your nephrostomy drainage catheter. Your doctors will talk to you about the best way to take care of your specific situation.


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