Percutaneous nephrostomy is a procedure to insert a flexible tube into the kidney so that urine can leave the body. This procedure may be done if a medical condition prevents urine from leaving the kidney in the usual way. Urine is normally carried from the kidneys to the bladder through narrow tubes called ureters. A ureter can become blocked due to conditions such as kidney stones, tumors, infection, or blood clots.

The nephrostomy tube will be inserted through your back. After the procedure, the tube will remain in place, and urine will drain from the kidney into a drainage bag outside your body. Draining the urine will relieve pressure and help prevent infection that could damage the kidney. Often, this procedure allows the health care provider to identify the cause of the blockage and plan appropriate treatment.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

• Infection.
• Bleeding.
• Allergic reactions to medicines or dyes used in the procedure.
• Damage to other structures or organs.

What happens before the procedure?

Staying hydrated

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

• 8 hours before the procedure – stop eating heavy meals or foods, such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• Taking over-the-counter medicines, vitamins, herbs, and supplements.

Tests

• Blood tests to see how well your kidneys and liver are working and to see how well your blood clots.
• Urine tests.
• Imaging studies such as ultrasound or CT scan.

General instructions

• Do not use any products that contain nicotine or tobacco for at least 4 weeks before the procedure. These products include cigarettes, e-cigarettes, and chewing tobacco. If you need help quitting, ask your health care provider.
• Plan to have someone take you home from the hospital or clinic.
• Ask your health care provider:
  • How your surgery site will be marked.
  • What steps will be taken to help prevent infection. These may include:
    • Removing hair at the surgery site.
    • Washing skin with a germ-killing soap.
    • Receiving antibiotic medicine.

What happens during the procedure?

• An IV will be inserted into one of your veins.
• You will be positioned on your abdomen.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area (local anesthetic) where the nephrostomy tube will be inserted.
  • A medicine to make you fall asleep (general anesthetic).
• A needle will be inserted into your body and guided to your kidney. An imaging method that uses X-ray images (fluoroscopy) will be used to help guide the needle to your kidney.
• A dye will be injected through the needle. Then, X-ray images that highlight your kidney will be taken.
• A wire will then be passed through the needle. A tool to widen the path (dilator) for the nephrostomy tube will be inserted and removed. Then the nephrostomy tube will be inserted over the wire and into your kidney.
• Next, the wire will be removed, but the nephrostomy tube will be left in your kidney. The tube may be secured to your skin with stitches (sutures).
• A bandage (dressing) will be placed on the nephrostomy tube site.
• A drainage bag will be attached to the nephrostomy tube. Urine will be able to drain from your kidney to this drainage bag outside of your body.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital or clinic.
• You will be taught how to care for the nephrostomy tube and the drainage bag.
• If you were given a sedative during the procedure, it can affect you for several hours. Do not drive or operate machinery until your health care provider says that it is safe.

Summary

• Percutaneous nephrostomy is a procedure to drain urine from a kidney when the normal drainage route is blocked.
• Follow instructions from your health care provider about taking medicines and about eating and drinking before the procedure.
• The nephrostomy tube will be inserted through your back.
• After the procedure, the tube will remain in place, and urine will drain from the kidney into a drainage bag outside of your body.