Nephrostomy
What is a percutaneous nephrostomy?
Percutaneous means through the skin and a nephrostomy is a tube put into the kidney. The urine from a normal kidney drains through a narrow tube, the ureter, into the bladder. When a stone or a blood clot blocks that tube, the kidney can be damaged. It may be possible to drain the urine by inserting a fine plastic tube, called a catheter, through the skin and into the kidney under local anaesthetic. The urine drains from the kidney into a collecting bag outside the body.
The procedure takes usually place in an x-ray "screening" room. It may be done in an operating theatre, using mobile x-ray equipment or a portable ultrasound scanner.
The exact technique may vary slightly but the general outline of the procedure is as follows.
You will lie on the on your stomach on the x-ray table. You will have a needle put into a vein in your arm so that the radiologist can give you a sedative or painkillers. Once in place, this needle does not cause any pain. You will also have monitoring devices attached to your chest and finger, and may be given oxygen. It will be done as a sterile procedure.
The radiologist will use the x-ray or ultrasound equipment to guide the fine plastic tube (catheter). Usually this will be in your back, just below your ribs. Your skin will be anaesthetised with local anaesthetic and a fine needle inserted into the kidney.
Percutaneous nephrostomy is a safe procedure but some risks and complications can arise, as with any medical treatment.
In almost all cases some blood will appear in the urine. This is not dangerous as usually stops within a few hours.
Occasionally the radiologist is unable to place the drainage tube satisfactorily in the kidney. If this happens another method of overcoming the blockage will be arranged.
Sometimes there is a leak of urine from the kidney causing a small collection of fluid inside the abdomen. If this becomes large it may require draining.
There may be bleeding from the kidney. On rare occasions this may become severe, and will require an operation to stop it. Infection in the kidney can generally be treated satisfactorily with antibiotics.
Major complications, including death occur in less than 0.5% of percutaneous nephrostomies.
You will probably be asked not to eat for four hours beforehand but you may be allowed to drink some water. You may receive a sedative and an antibiotic. You will be asked to put on a hospital gown.
If you have any allergies, you must let your doctor know. If you have reacted to intravenous contrast medium, the dye used for kidney x-rays and CT scanning, then you must tell your doctor.
There may be some discomfort for a short period of time, but any pain you have should be controlled with painkillers.
A local anaesthetic is injected. Later you may be aware of the needle passing into the kidney, especially if the kidney was sore to start with. There will be another member of staff looking after you and your comfort.
Generally, placing the catheter in the kidney only takes a short time, and once in place it should not hurt at all.
You will be taken back to your ward where routine observations will be carried out. You will usually stay in bed for a few hours.
The drainage catheter stays in place in your body and will be attached to a collection bag. You will be able to carry on a normal life with the catheter in place. However, it is important that you try not to make any sudden movements without remembering about the bag.
Only the doctors looking after you can answer these questions. Taking the catheter out does not usually hurt.
Partly taken from www.bsir.org
by The Royal College of Radiologists,
July 2000.