A nephrostomy is the insertion of a small, flexible rubber tube that is surgically placed through the skin into the kidney to directly drain urine. Also known as a percutaneous nephrostomy, this procedure is generally performed to treat conditions such as hydronephrosis, kidney stones, or a hole in the ureter or bladder. The ureter is a tube that carries urine from the kidney to the bladder. If the ureter is blocked, urine will back up into the kidney, possibly causing kidney damage, infection, and pain.
The procedure is generally a temporary treatment for medical issues affecting organs in the urinary tract. It can also be performed in preparation for another surgery or procedure planned for a kidney or ureter in the future. The procedure is generally performed in a hospital or surgery center. A patient lies on an x-ray table, face down. After appropriate measures are taken to clean the area and ensure a sterile field on the body, the area in which the tube will be inserted is numbed with an injection of lidocaine or Xylocaine™.
A nurse is usually present to monitor the patient's vital signs, as well as pain and anxiety levels. Medical staff, generally a radiologist, will use x-rays or an ultrasound to locate the kidney. At this point, a needle is inserted directly through all layers of skin into the kidney. X-ray dye is inserted through the needle to aid in insertion of the catheter. The catheter is inserted into the kidney, and is sometimes secured by a stitch when it is to be left in place for an extended period of time.
After successful insertion, a sterile dressing is placed over the nephrostomy site. The end of the catheter is connected to a drainage bag, which is most often worn attached to the leg by two rubber straps. Urine will then bypass the kidney and flow through the catheter into the drainage bag. The urine should be monitored for the presence of blood, which should begin to clear shortly after the nephrostomy procedure. When kidney stones are an issue, patients may be instructed to strain urine when emptying the drainage bag to monitor for presence and size of kidney stones.
Patient education about proper care of the nephrostomy site, drainage bag, and catheter tube is generally performed by a nurse prior to the patient being released from the medical facility. Some minor pain and discomfort is generally felt at the nephrostomy site, but generally declines with time and proper care. Failure to properly secure the drainage bag can result in damage to the nephrostomy site if it becomes caught or is accidentally pulled. This can result in bleeding, infection, or even the need to perform the procedure again. Placement is usually necessary until any blockage has resolved itself or other medical issue has been resolved.
