What is a nephrostomy?
A nephrostomy means that a thin, plastic tube is inserted through the skin on your back right into your kidney. In some cases, you might have two tubes, one into each kidney. This procedure is usually done when you’re unable to pass urine via “the normal route” due to a blockage in the ureters. Once inserted, your nephrostomy will drain urine straight from your kidneys into a collection bag that is either strapped to your waist or leg. This allows you to move freely and you can reach it easily when it needs emptying.
A nephrostomy can help your kidneys to function properly, clear any existing infections and protects them from any further damage. Most of the urine will leave your body via your urostomy tube(s) but you might still pass a little bit the normal way. The procedure is a great option to reduce any strain on the kidneys without having to have surgery. This gives your doctor time to figure out how to treat the blockage in your ureters. Once the blockage is removed and you are able to pass urine normally again, your nephrostomy tubes can be removed, and your urinary tract will work as normal again.
What can lead to a nephrostomy?
As we already know, a nephrostomy is usually performed when one or both of your ureters are blocked. But what can be the cause for such a blockage? Sometimes, it is not clear what the cause of the blockage is, but most common causes are kidney stones, a severe kidney infection, injury, trauma, or cancer. Your ureters are more likely to become blocked when the cancer started in your pelvic area or has spread in that area.
What are the potential risks of a nephrostomy?
Although a nephrostomy is generally considered a safe procedure, complications are possible. The most common risk is, that you develop an infection. So, if you experience any of the following symptoms after your nephrostomy procedure, please do get in touch with your nurse or doctor:
- Pink or red urine
- Swelling, redness, or tenderness at the side of your dressing
- Fever (temperature above 38.3 C)
- Pain in your side or your lower back
- Very dark, cloudy, or bad smelling urine
- Chills
Although quite rare, other possible complications include:
- Leaking of urine
- Injury of nearby structures with the needle
- Bleeding
- A dislodged nephrostomy tube
There is also a chance for your nephrostomy tubes to become blocked. So, if you experience any of the following symptoms, please get in touch with your nurse or doctor.
- You are unable to flush your tubing
- Poor or no urine drainage for over 2 hours
- Leaking of urine from the dressing or the tube
- Your nephrostomy tube falls out
The procedure
Before the procedure
Before your nephrostomy procedure it is important that you tell your doctor about any medications or supplements that you’re currently taking. There are some medicines, like blood thinners, that you might have to stop taking prior to your procedure but your doctor will instruct you when to stop taking them. Do not stop taking any tablets without consulting with a nurse or doctor first. Your doctor might also tell you to not eat anything from the evening before your surgery, but you may be allowed to drink some water. Make sure to tell your doctor about any allergies, especially if you’ve previously had a bad reaction to an intravenous contrast medium. This is the special dye that is used for kidney X-rays and CT scanning. If you develop any symptoms of an infection shortly before your procedure – like fever or night sweats – let your nurse or doctor know about it. It might not be safe for you to have your nephrostomy done with an infection.
A nephrostomy is an in-patient procedure. This means that you will have to stay in hospital for a few days before and after the surgery.
During the procedure
When it’s time for your nephrostomy, your doctor will inject a local anaesthetic where the tube will be inserted. To make sure it is placed correctly, ultrasound, a fluoroscopy, or a CT scan will be used. Once the tube has been inserted and your doctor is sure that it is in the right spot, a small disk will be attached to your skin to hold the tube in place. For the procedure itself, you will lie almost flat on your stomach, often on an X-ray table, and most of your body will be covered with the theatre towel. How long does it take? This is different from person to person and fully depends on whether there are complications during the procedure or not. There is a chance that it might be over in 20 minutes or, if it doesn’t go to plan, it might take longer than 90 minutes.
If you need a nephrostomy is needed for a longer period of time, it will need to be exchanged periodically. A little bit like a urinary catheter, really. Changing it will be much less of a hassle, though, and is usually carried out as an outpatient procedure.
After the procedure
Right after your procedure, you might be in a bit of pain. This usually only lasts for a short period of time, however, and can easily be managed with painkillers. You might also experience some bruising and your urine can be a little blood stained. These problems usually all clear up within the first 1 to 2 days. Please make sure to mention it to your nurse or doctor if this isn’t the case! Even though you won’t be put under general anaesthetic you will likely be required to remain in bed for a few hours after the procedure. This is more of a safety precaution – just to make sure that you don’t hurt yourself if you happen to get a little lightheaded.
Especially during the first period of time it is important to avoid sudden movements as much as possible. Getting off the sofa and completely forgetting about your bag is good example here. Don’t worry if it happens, though; you’re not the only one. You should also make sure that you empty your bag fairly frequently to make sure that it doesn’t become too heavy.
A nephrostomy is often not permanent, and you might only need it for a short period of time. Once the reason for the nephrostomy has been treated, it can be removed by your nurse or doctor without any further intervention.
Looking after your nephrostomy
Your drainage bag, usually worn underneath your clothes, must always be kept lower than your kidneys. This is important because otherwise the urine won’t be able to drain out of your body and you risk an infection. To avoid having to change your bag at night, you can attach a larger overnight drainage bag that has enough capacity to collect all the urine overnight. Your dressing will need to be changed once a week. This can either be done via a district nurse that will come to check up on you or you can do it yourself after a healthcare professional has shown you how. Your nephrostomy tube will also need to be flushed at least once a day. Your doctor or nurse will tell you exactly how and how often you have to do this. In addition to this, there are three golden rules that you should always follow:
- Make sure to always wash your hands before and after you change your bag or the dressings
- Change your bag as frequently as your nurse or doctor told you to
- Drink plenty of fluids! You should aim to drink around 4 pints, preferably water, a day to help reduce the risk of a urinary infection
If you’re at home, and you are worried about your nephrostomy in any way, you should always speak to your nurse or doctor. It’s better to be safe than it is to be sorry, after all. If you’re simply looking for a little reassurance, you can always ring our customer care team. Make sure to speak to a healthcare professional immediately, if you experience signs of a urinary infection as you might need antibiotics to treat it. Symptoms of a urinary infection include:
- Cloudy or strong-smelling urine
- Blood in your urine
- Pain when passing urine the normal way
If the area around your nephrostomy tube becomes uncomfortable, looks red or swollen, or feels warm, you might be developing an infection that needs treating as soon as possible in order to avoid long-term complications.