Nephrostomy is a surgical procedure in which a thin plastic/rubber tube or catheter (nephrostomy tube) is inserted through your back to reach up to your kidney.
A nephrostomy tube can remain in the kidney as long as the obstruction in your urinary tract does not get relieved. It may need to stay in for a short time such as till a stone passes naturally. It may be needed for only two to three days, or it may need to stay in for a much longer period to allow a more permanent solution for the blockage to be organized. It creates a passage for the urine to bypass the bladder and pass outside the body into a bag (placed near to your body). Based on the underlying cause of the obstruction (a stone or narrowing of the ureter) and your situation, the doctor can tell you how long the tube needs to stay in its place. If the causative problem is treated, your doctor will remove the tube. If the problem persists, the opening of the nephrostomy will remain permanent, and the tube will need to be changed periodically.
What is a nephrostomy?
Nephrostomy is a surgical procedure in which a thin plastic/rubber tube or catheter (nephrostomy tube) is inserted through your back to reach up to your kidney. One end of the nephrostomy tube is connected to the kidney, and the other end is attached to a bag placed outside your body. If you are not able to pass urine through your urethra due to the buildup of pressure in your bladder, you can urinate through this tube into the bag (by opening the tube’s tap).
Why is a nephrostomy performed?
Your doctor may recommend you a nephrostomy if
- You have an obstruction in the urinary flow.
- The size of your kidney stone is very large.
- The treatment for kidney stone fails to relieve your pain (renal colic).
- You get frequent urine infections due to the kidney stone.
- Your kidneys are getting damaged due to the kidney stone.
What is done before a nephrostomy?
Tell your doctor if you are on any medications such as blood-thinning ones (Aspirin and warfarin), any herbs, and supplements. You may be asked to discontinue them a few days before the surgery.
Inform your doctor if you are or think you could be pregnant.
Your doctor may ask you to fast a night before a nephrostomy (in case of general anesthesia).
How is a nephrostomy performed?
The nephrostomy procedure may be performed by either a urologist or radiologist. A urologist is a doctor who is specialized in treating disorders of the urinary tract, whereas a radiologist is a doctor who has specialization in diagnosing and treating diseases using medical imaging procedures such as X-rays, computed tomography (CT) scans, and so on.
You will be given sedatives or local anesthetic medication to make the surgical area numb. Alternatively, the doctor can plan to give you general anesthesia that makes you numb throughout the procedure.
Next, the doctor inserts a needle into your back. They make use of an X-ray or ultrasound to check if the needle has been inserted properly to reach the kidney. They then insert a wire through this needle. The nephrostomy tube is inserted over this wire. A contrast (X-ray dye) may be injected through this tube, and an X-ray will be taken to check if the tube has been placed correctly. Instead of an X-ray, an ultrasound may be used. Next, the wire is removed, and the tube is properly fixed in its position into the kidney. Doctors use stitches or dressings to secure the tube on the skin. The tube is attached to a bag for collecting the urine. The bag is generally strapped to your legs.
What are the complications of the nephrostomy procedure?
A nephrostomy procedure is generally safe. Possible risks include:
- Hemorrhage (bleeding)
- Kidney infection
- Kidney damage
- Tube blockage
- Damage to the structures (during the surgery)
- Allergic reaction to contrast injection