Nephrostomy Overview

A nephrostomy is a procedure in which a catheter (tube) is placed into the kidney. The catheter is guided into the kidney by CT scan or ultrasound .

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:

• Anti-inflammatory drugs (eg, aspirin )
• Blood thinners like clopidogrel (Plavix) or warfarin (Coumadin)

Anesthesia

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?

15-30 minutes

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.

Post-procedure Care

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.

At Home

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 .

RESOURCES:

American Urological Association Foundation
http://www.urologyhealth.org/index.cfm

National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov/

National Kidney Foundation
http://www.kidney.org/

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca/index_e.html

The Kidney Foundation of Canada
http://www.kidney.ab.ca

References:

Nephrostomy. Encyclopedia of Surgery website. Available at: http://www.surgeryencyclopedia.com/La-Pa/Nephrostomy.html . Accessed September 21, 2009.

Percutaneous nephrostomy tube. University of Virginia Heath System website. Available at: http://www.healthsystem.virginia.edu/internet/radiology/angio/angio-pted-nephrostomy.cfm . Accessed September 21, 2009.

Practice guideline for the performance of percutaneous nephrostomy. American College of Radiology website. Available at: http://www.acr.org/SecondaryMainMenuCategories/qualitysafety/guidelines/iv/percutaneousnephrostomy.aspx . Accessed September 21, 2009.

Professional Guide to Diseases. 9th ed. Ambler, PA: Lippincott Williams & Wilkins; 2009.

Savitsky D. Kidney stones. EBSCO Health Library. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15&topicID=81 . Last reviewed November 2008. Last updated November 17, 2008. Accessed September 21, 2009.

Skolarikos A , Alivizatos G , Papatsoris A , Constantinides K , Zerbas A , Deliveliotis C . Ultrasound-guided percutaneous nephrostomy performed by urologists: 10-year experience. Urology. 2006 Sep;68(3):495-9. Epub 2006 Sep 18.

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.