What does the procedure involve?
Insertion of a small tube into the kidney (usually under local anaesthetic), which allows urine to drain into a collecting bag outside the body.
What are the alternatives to this procedure?
Alternatives to this procedure include no treatment (observation only) and insertion of an internal stent under general anaesthetic.
What should I expect before the procedure?
You will usually be admitted to hospital on the day of your surgery unless the tube insertion is being performed during an emergency admission.
You will be asked not to eat and drink for four hours before surgery.
Immediately before the procedure, you will be given an injection of antibiotics to prevent infection. If you have any allergies, you must let your doctor know. If you have previously reacted to the dyes used for kidney X-rays and CT scans, you must tell your doctor straight away.
Please tell your surgeon (before your surgery) if you have any of the following:
- An artificial heart valve.
- A coronary artery stent.
- A heart pacemaker or defibrillator.
- An artificial joint.
- An artificial blood-vessel graft.
- A neurosurgical shunt.
- Any other implanted foreign body.
- A regular prescription for warfarin, aspirin or clopidogrel (Plavix®).
- A previous or current MRSA infection.
What happens during the procedure?
You will lie on an X-ray table, usually flat (or nearly falt) on your stomach. You may have a needle put into a vein in your arm so that can be given a sedative or painkillers. The procedure will be performed by a specially trained doctor called a radiologist or your Urologist.
The radiologist will use X-rays or ultrasound to find the best point for inserting the fine catheter into your kidney. Your skin will be anaesthetised with local anaesthetic and a fine needle inserted into the kidney. Once the radiologist is sure that the needle is in the correct position, a guidewire is passed through the needle and a plastic catheter is threaded over the guidewire. The catheter is fixed to the skin of your back and attached to a drainage bag (pictured).
The procedure will normally take 20 minutes or so but, occasionally, it may take longer.
What happens immediately after the procedure?
Once you return to the ward, the nurses will perform routine observations of your pulse, temperature and blood pressure. You will normally asked to stay in bed for a few hours until you feel comfortable. Once you are free to move about, you should avoid sudden movements to prevent the tube from being pulled out.
Your drainage bag needs to be emptied frequently so that it does not become too heavy.
The nurses will monitor your urine output carefully during this period.
Are there any side-effects?
Most procedures have possible side-effects. But, although the complications listed below are well recognised, most patients do not suffer any problems.
Common (greater than 1 in 10)
- Minor bleeding from the kidney (visible in the urine drainage bag).
- Short-lived discomfort in the kidney and at the insertion site.
Occasional (between 1 in 10 and 1 in 50)
- Failure to place the tube satisfactorily in the kidney.
- Leakage of urine around the catheter inside the abdomen.
- Blockage of the drainage tube.
- Displacement of the drainage tube.
- Generalised infection (septicaemia) following insertion.
Rare (less than 1 in 50)
- Significant bleeding inside the abdomen requiring surgical drainage.
- Inadvertent damage to adjacent organs (e.g. stomach, bowel).
After you go home
our urologist will decide how long your drainage tube needs to stay in place. You should try to keep the skin around the nephrostomy tube clean and, to prevent infection; you should put a sterile dressing where the tube leaves your skin. These dressings should be changed at least twice a week, especially if they get wet.
You may shower or bathe 48 hours after the tube has been inserted but try to keep the tube site itself dry. You can protect the skin with plastic wrap during showering or bathing. After 14 days, you do not need any protection for the tube while washing but swimming is not recommended with a nephrostomy tube.
What else should I look out for?
If you experience a high temperature, back pain, redness or swelling around the tube, leakage of urine from the drainage site, poor (or absent) drainage or if the tube falls out, you should contact your Urologist immediately. In case of an emergency attend your nearest emergency department or call ‘000’.
Are there any other important points?
Any subsequent follow-up or treatment will be arranged by your urologist before your discharge. If your tube needs to be removed at any stage, this must be performed in hospital and you should contact your urologist or specialist nurse.
Disclaimer
This information is intended as a general educational guide and may not apply to your situation. You must not rely on this information as an alternative to consultation with your urologist or other health professional.
Not all potential complications are listed, and you must talk to your urologist about the complications specific to your situation.