Pronounced: Purr-cue-TAY-knee-us Nef-RAW-stow-me
Reasons for Procedure
A nephrostomy is done to drain urine from your kidney. This needs to be done when urine cannot come out through the ureters, bladder, and urethra as it normally does. Specific conditions that may cause this include:
- Damage to the bladder
- Blockage in ureter (tube that carries urine from the kidney to the bladder) due to:
- Kidney stone]]>
A nephrostomy may also be used to look at the kidneys and ureters before other procedures are done, like kidney stone removal. This may also help your doctor make a diagnosis.
Complications are rare, but no procedure is completely free of risk. If you are planning to have a nephrostomy, your doctor will review a list of possible complications, which may include:
- Damage to nearby organs and tissue
- Kidney function loss
- Blood clots
- Reaction to the anesthesia (eg, light-headedness, low blood pressure, wheezing)
Factors that may increase the risk of complications include:
- Liver failure
- Use of blood thinners
- Long-term illness
What to Expect
Prior to Procedure
- At the appointment before the test:
- Your doctor may do tests like a CT scan or ultrasound. She may also do blood and urine tests.
- Questions your doctor may ask include: Are you pregnant? Do you have any allergies to contrast dye?
- Questions you should ask your doctor include: How long will the catheter need to stay in place? What signs should I look for in case there is a problem with the catheter?
- Arrange for a ride home from the hospital.
- Do not eat or drink for eight hours before your procedure. If you are taking medicines, ask your doctor if you should take them the morning of your procedure with a sip of water.
- Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure like:
You will receive a local anesthetic to numb the skin on your lower back. An IV (needle in your vein) will be placed. You will receive a sedative, pain medicine, and antibiotics through this IV.
Description of Procedure
A nephrostomy is usually done in an outpatient setting, and you will not need to stay in the hospital overnight. The procedure is done either by a doctor called an interventional radiologist or a urologist. First, you will be asked to lie on a special x-ray table. An IV will be placed to give you medicine to help you relax. Your lower back will be washed with an antiseptic. Next an anesthetic will be injected into your lower back. Ultrasound or ]]>x-ray]]> images will be used to locate your kidney and guide the doctor. A needle will be inserted through your skin and into your kidney. The doctor will inject contrast material through the needle to better view the kidney on the x-ray. The catheter will then be placed into your kidney. The catheter will come out of your skin and be attached to a collection bag. A dressing will be placed at the insertion site. Urine will drain from your kidney into the collection bag.
Immediately After Procedure
After the procedure, you will be monitored for 8-12 hours to make sure the catheter is draining urine. At first the urine may appear bloody, but it will clear over time.
How Long Will It Take?
How Much Will It Hurt?
You may feel soreness at the insertion site for several days after your nephrostomy. Your doctor will give you medicine to help with the pain.
At the Care Center
After the procedure, the staff may give you the following care to make you more comfortable and to help your recovery:
- Your collection bag will be checked to make sure the catheter is draining your kidney well.
- You will be shown how to care for your catheter. You will be sent home with extra collection bags and dressing supplies.
You will be able to leave when your catheter is working and you are comfortable caring for it.
When you return home, do the following to help ensure a smooth recovery:
- Ask someone to stay with you for the first 24 hours after the procedure.
- Keep the insertion site and dressing dry. Protect it from getting wet when showering. You can use plastic wrap to cover it.
- Do not let the collection bag get too full before emptying it.
- Change your dressing every 2-3 days. If your dressing gets wet, loose, or dirty, change it. Always wash your hands before changing your dressing.
- Be sure to follow your doctor’s instructions.
Call Your Doctor
After arriving home, contact your doctor if any of the following occurs:
- Catheter problems:
- Urine no longer drains
- Catheter is bent or twisted
- Leakage around the catheter
- Signs of infection, including fever or chills
- Urine becomes cloudy, bloody, or smells bad
- Sudden pain
- Redness, swelling, increasing pain, a lot of bleeding, or any discharge from the incision site
- Pain that you cannot control with the medicines you have been given
In case of an emergency, CALL 911.
American Urological Association Foundation
Diabetes and Digestive and Kidney Diseases
National Kidney Foundation
The Kidney Foundation of Canada
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Practice guideline for the performance of percutaneous nephrostomy. American College of Radiology website. Available at: http://www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/iv/percutaneous_nephrostomy.aspx. Accessed September 21, 2009.
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Wen X , Gao X , Li X , Lu M , Cai Y , Qiu J , Xiao C . One-step percutaneous nephrostomy in patients with a history of open nephrolithotomy: comparison with the fascial dilator system. J Endourol. 2007 Nov;21(11):1281-5.
Last reviewed October 2009 by ]]>Adrienne Carmack, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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