Nephrostomy

Nephrostomy is a surgical opening in the kidney through which a catheter (thin plastic tube) is inserted inside a kidney through the skin at the back. The incision in the kidney is called a nephrotomy. However, the terms nephrostomy and nephrotomy are both used interchangeably. In this article, we are using the term nephrostomy for the procedure.

Nephrostomy is recommended when you have a blocked ureter. Ureters are a pair of tubes which help transfer fluids from the kidneys to the bladder where the fluid is temporarily stored before it is expelled as urine.  

If you have a blocked ureter, the urine will not flow out of the body and accumulates inside the kidney. This may cause kidney damage. 

Nephrostomy helps to relieve this buildup of urine inside the kidney and prevents damage to the kidney. The catheter will drain urine directly from the kidneys into a collecting bag placed outside the body. The tube can be removed when the blockage in the ureter has resolved.

Your healthcare practitioner will perform this surgery if you have a blockage in your ureter. The ureter can be blocked due to the following conditions:

• Benign (noncancerous) prostatic hyperplasia, in which the prostate (a male reproductive organ that produces semen, a fluid that contains sperms) is enlarged. Read more: Enlarged prostate symptoms
• Ureteral stones (a condition in which kidney stones get stuck in the ureter).
• Blood clots or vascular (blood vessel) diseases 
• Ureteropelvic junction obstruction (a genetic disorder that causes blockage of the ureter at the junction where it is attached to the kidney) 
• Gastrointestinal diseases like Crohn’s disease, swollen appendix, or diverticulitis
• Tumours, scar tissue, or cysts in the abdomen 

The symptoms of a blocked ureter include:

• Swollen legs 
• Pain in the abdomen 
• Frequent urination
• Nausea or vomiting
• Fever
• Frequent urinary tract infections 
• Bloody or cloudy urine

Usually, nephrostomy can be performed in all individuals. However, it may be avoided if you have a urinary tract infection that is left untreated.

Before this procedure, you may need the following preparation:

Diagnostic tests: Your healthcare practitioner will perform the following tests before the surgery:

• X-ray
• Ultrasound scan
• Computed tomography (CT) scan 
• Magnetic resonance imaging (MRI)
• Blood tests

Fasting: Your healthcare practitioner will ask you to not eat or drink for at least six hours before the surgery.

Medicines: 

• Inform your doctor if you are taking any medicines including over-the-counter medicines, supplements, or herbs.
• Let your doctor know if you are allergic to anything such as contrast medium (an X-ray dye) or medication.

Medical history: Inform your healthcare practitioner if you have the following:

• A history of the bladder or kidney surgery
• Any history of kidney diseases 
• Symptoms of infections like fever or night sweats 
• Previous dental work, excessive bleeding from a surgery or an injury that showed blood-clotting issues

Lifestyle: Tell your healthcare practitioner if you drink excess alcohol or smoke as it can increase your risk of complications after the surgery.

You will need to arrange a family member or friend to drive you home after the surgery. Your doctor will ask you to sign a consent form before the surgery to give permission to perform the procedure.

The following steps are performed in this surgery:

• You will be taken to the operation theatre.
• A tube or cannula will be inserted intravenously (through the vein) in your hand or arm. This line will be used to administer fluids to you during the procedure.
• You will be given sedative medicines through an injection and asked to lie slightly on your side or on your stomach so the surgeon can easily access your kidney. 
• A healthcare practitioner will clean the area on your skin that is to be operated on. 
• Next, your doctor will choose the position for placing the catheter (nephrostomy) and inject local anaesthesia to numb the area. 
• He/she will make a small cut in your skin over this area. 
• Next, the surgeon will position a thin needle into your kidney through your skin with the help of ultrasound or X-ray. He/she will confirm the position of the needle by injecting a contrast dye.
• After confirming the position of the needle, the surgeon will place a wire into your kidney through the needle and remove the needle.
• He/she will then place the nephrostomy tube above the wire and take out the wire too. The tube will be fixed in place using a string.
• The surgeon will confirm the final position of nephrostomy by injecting a contrast dye in the area.
• In the end, the surgeon will connect a drainage bag to the nephrostomy tube to collect urine
• This procedure takes about half an hour.

After the surgery, the medical staff will shift you to the recovery room where you will be monitored for about eight to 12 hours to check if the tube is draining urine in the bag. 

A nurse may remove the tube once the underlying condition (for which the procedure is performed) has been treated. However, a nephrostomy tube may be needed for long-term in conditions like spinal cord injury. In such a case, your doctor will teach you how to care for the tube. You will be discharged within 24 hours after the surgery.

Once you are home after a nephrostomy surgery, the following care should be taken:

Wound care:

• Keep the skin near the wound clean. 
• Put a sterile dressing around the tube to prevent infection. 
• Change the dressing at least twice a week.
• Wash your hands before changing the dressing.

Nephrostomy care:

• Place the urinary bag below the level of kidneys. 
• Empty the bag before it fills up. 
• Clean the drainage bag every week. A solution of water and vinegar in equal proportion can be used to wash it. Rinse with water and use after drying it. 

 Activity:

• Avoid swimming until the tube is removed. 
• Do not do any activity that causes pain or pulls on the catheter.

Medicines:

• You may be given painkillers.

Showering:

• You can shower or bath two days after the surgery by covering the dressing with a plastic wrap. 

Make sure to drink a minimum of two litres of fluid each day. This will reduce the risk of infections.

A nephrostomy helps to prevent kidney damage and restore kidney function.

When to see the doctor?

Visit or call your healthcare practitioner in case of the following symptoms:

• Vomiting 
• Fever and chills
• Pain in your side or back that does not subside or gets worse
• Urine that appears cloudy or has a foul smell 
• Blood in urine after the first few days 
• Pain or redness in the skin around the tube 
• Leakage of urine around the catheter
• The catheter stops draining urine into the bag 
• Pus or blood in the drainage 

The risks of this surgery include:

• Infection
• Tube dislodgement or blockage
• Severe bleeding 
• Allergic reaction to contrast dye

You will need a follow-up meeting a few days after the surgery to check if urine is properly draining through the tube. The doctor will again inject a dye and check kidney function.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.