Nephrostomy
Nephrostomy, also known as percutaneous nephrostomy, is a medical procedure that involves creating an opening to insert a nephrostomy tube into the kidney for urine drainage. This tube is connected to a bag that collects urine, helping to alleviate blockages caused by tumors or other conditions affecting the urinary tract. Such blockages can lead to significant health risks, including kidney damage and infection, making nephrostomy an important intervention.
The procedure is typically performed in a hospital setting by an interventional radiologist or urologist and may involve imaging techniques for precise tube placement. Prior to the procedure, patients usually undergo several preparatory steps, including fasting and potential adjustments in medication. After insertion, patients are monitored for complications, and proper aftercare instructions are provided to ensure the nephrostomy site is managed safely.
While nephrostomy tubes are generally intended for short-term use, some patients may require them on a long-term basis if blockages cannot be resolved. As with any medical procedure, nephrostomy carries certain risks, including bleeding, infection, and potential complications related to the catheter. Overall, nephrostomy serves as a critical option for managing urinary tract issues, particularly in patients with specific types of cancers.
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Subject Terms
Nephrostomy
ALSO KNOWN AS: Percutaneous nephrostomy (PCN), nephropyelostomy
DEFINITION: Nephrostomy is a procedure in which an opening is made, and a nephrostomy tube (catheter) is placed into the kidney to drain urine out of the body. Urine is collected in a bag attached to the nephrostomy tube. The procedure is done through a surgical incision or percutaneously (through the skin).
Cancers treated:Ovarian cancer, cervical cancer, colorectal cancer, advanced prostate cancer, and other cancers of the pelvic area
Why performed: Tumors may cause a blockage of one or both of the ureters, the tubes that normally carry urine from the kidneys to the bladder. The blockage causes a backup of urine into the kidneys, creating a great risk of infection and irreparable kidney damage. The insertion of nephrostomy tubes prevents the backup of urine. Nephrostomy tubes may also be placed during a diagnostic procedure called an antegrade pyelogram, which is done to determine the location of the blockage. In some cases, the nephrostomy tubes are inserted to allow the placement of anticancer drugs directly into the kidney. Nephrostomy tubes are also used for other conditions that affect the urinary tract.
Patient preparation: Nephrostomy is usually performed on hospitalized patients. Some patients may have the procedure done without admission to a hospital. Preparation for the procedure may vary depending on the patient’s condition, the physician’s practice, and the facility. Generally, the patient must not have anything to eat or any opaque fluids to drink for six to eight hours before the procedure. Clear, nonalcoholic fluids may be consumed up until a few hours ahead. The physician may ask the patient to temporarily stop or adjust the dose of some medications, including aspirin, blood thinners, and diabetes medications. Laboratory tests such as a complete blood count (CBC), coagulation tests, urinalysis, and urine culture for bacteria may be ordered before the procedure. The physician discusses the procedure, including the type of local anesthetic used, sedation, risks, and aftercare. The patient gives the physician permission to perform the procedure by reading and signing a consent form. Before signing the form, the patient may ask the physician questions to clarify anything the doctor has said or any part of the consent form the patient does not understand.
Steps of the procedure: An intravenous (IV) line is inserted, usually in the patient’s arm or hand, to provide fluids, antibiotics, pain medication, and sedation. Nephrostomy is generally performed in the interventional radiology department by an interventional radiologist or urologist. The patient lies on their stomach and remains awake, although medication is given that may cause drowsiness. Blood pressure, heart rate, and oxygen level are monitored throughout the procedure. Imaging procedures, such as ultrasound, computed tomography (CT), or fluoroscopy, are used to visualize the area. These procedures are done before and during the insertion of the nephrostomy tube to guide the physician in placing the tube. The tube must be placed below the twelfth rib to avoid puncturing the diaphragm.
The site where the tube will be inserted is sterilized. A medication such as lidocaine (Xylocaine) is given to numb the skin and tissues. A small incision is made, and a needle is inserted into the kidney. Contrast dye is sometimes injected for visualization, and the nephrostomy tube is inserted. The needle is removed. A dressing is placed over the site, and the nephrostomy tube is connected to a drainage bag. The tube site is on the right or left side of the back near the waistline, depending on which kidney is blocked. If both kidneys are blocked, the physician will insert tubes for each kidney. The procedure usually takes about one hour.
After the procedure: The patient is taken to the recovery room or back to the hospital room. A nurse will monitor the patient for any changes in blood pressure, heart rate, or breathing. The nurse monitors the urine output by measuring the urine collected in the bag. The bag may be attached to the patient’s leg using the provided straps. Before discharge, the physician or a nurse will give the patient instructions on caring for the nephrostomy site, emptying the bag, monitoring the urine output, and noting signs of complications. Patients may need others to assist them in caring for the site and emptying the bag at home. In addition to the urine drained through the nephrostomy tube, the patient will still need to urinate. If only one tube is placed but the other kidney works normally, the urine from that kidney still passes into the bladder. Some urine may still drain into the bladder if nephrostomy tubes are placed in both kidneys.
Risks: The risks of nephrostomy include bleeding, infection, blood clots in the nephrostomy tube or bladder, and dislodgement of the nephrostomy tube. Though rare, a leak may occur, resulting in fluid buildup in the abdomen, called ascites. If bleeding occurs, it usually resolves in one or two days. Pain at the catheter site may also occur.
Results: The placement of nephrostomy tubes will alleviate the backup of urine in the kidneys or allow treatment to be given. Although their use is normally for a short time, the blockage cannot be removed in some cases, and the nephrostomy tubes remain in use permanently. In these cases, the tubes are replaced periodically to avoid infection.
Bibliography
Berman, Joel. Understanding Surgery: A Comprehensive Guide for Every Family. Branden, 2008.
Domino, Frank J. The Five-Minute Clinical Consult. 31st ed., Lippincott, 2023.
Hashim, Hashim, et al., eds. Urological Emergencies in Clinical Practice. Springer-Verlag, 2013.
Mondal, Utsav, et al. “Percutaneous Nephrostomy in Complicated Urinary Tract Infections.” Cureus, vol. 14, no. 7, 9 Jul. 2022, doi:10.7759/cureus.26682.
"Nephrostomy Tube." Cleveland Clinic, 20 July 2023, my.clevelandclinic.org/health/treatments/25141-nephrostomy-tube. Accessed 20 June 2024.
"Percutaneous Kidney Procedures." MedlinePlus, 1 Jan. 2023, medlineplus.gov/ency/article/007375.htm. Accessed 20 June 2024.
Young, Michael, and Stephen W. Leslie. "Percutaneous Nephrostomy." National Library of Medicine, 26 June 2023, www.ncbi.nlm.nih.gov/books/NBK493205. Accessed 20 June 2024.