Percutaneous Nephrostomy | Treatment Information, Complications & Doctors

A nephrostomy is usually a temporary solution to protect the kidney or to spare the urinary tract. In the long term, it is primarily used in palliative care—that is, when a patient’s overall poor health precludes therapeutic surgical procedures on the kidney, ureter, or bladder.

A nephrostomy is often an emergency measure when the urinary tract is blocked. It prevents urine from backing up, which leads to increased fluid pressure in the renal pelvis and can cause irreversible damage to the kidney tissue.

Possible causes of such a blockage of the urinary tract include:

• large kidney stones lodged in the ureter
• scarring or congenital malformations of the ureter
• benign prostate enlargement or tumors (colon cancer, ovarian cancer, or cervical cancer), if they constrict the ureter

A nephrostomy may also be indicated to temporarily relieve pressure on the urinary tract following surgery. Another reason for a planned nephrostomy is the impending or incipient loss of bladder function due to bladder cancer or other serious diseases.

Schematic representation of kidney stones

A nephrostomy is performed in the radiology or urology department of a hospital or on an outpatient basis at a urology practice. The surgical procedure is performed under local anesthesia; in addition, a sedative is administered to calm and relax the patient.

During the procedure, the patient lies flat on their stomach or on their side. Through a small incision, a puncture cannula connected to a plastic tube is first inserted from the back into the renal pelvis.

The urinary tract. 1: Kidney. 2: Renal pelvis. 3: Ureter. 4: Bladder. 5: Urethra

A nephrostomy is performed in the radiology or urology department of a hospital or on an outpatient basis at a urology practice. The procedure is performed under local anesthesia, and a sedative is also administered to help the patient relax.

During the procedure, the patient lies flat on their stomach or on their side. Through a small incision, a puncture cannula connected to a plastic tube is first inserted from the back into the renal pelvis.

The urinary tract. 1: Kidney. 2: Renal pelvis. 3: Ureter. 4: Bladder. 5: Urethra

The progress of the procedure is monitored in real time using a dynamic imaging technique—usually ultrasound, or possibly computed tomography (CT) or 3D fluoroscopy. When using one of the latter two techniques, a contrast agent or fluorescent dye is first injected through the catheter into the urinary tract.

A guidewire is then advanced through the catheter. The catheter and the puncture cannula are removed, and the catheter is advanced over the guidewire into the renal pelvis. At the body’s surface, the catheter is secured to the skin with a small surgical suture. A urine collection bag can be attached to the end of the catheter.

The entire procedure takes about an hour. Immediately following the nephrostomy, or at a later time, additional surgical procedures are usually performed, such as to correct an ureteral obstruction.

If the nephrostomy catheter is intended as a long-term solution, the silicone tube must be changed regularly to minimize the risk of infection and prevent the catheter from becoming blocked. This can be done on an outpatient basis and is necessary every four weeks to three months at the latest.

The catheter exit site is located at the level of the affected kidney on the side of the back. Even after it has healed, the patient must keep the site clean, disinfect it regularly, and cover it with sterile compresses and a special adhesive bandage that also holds the catheter tube in place. The patient wears the necessary urine collection bag using Velcro bandages or in a pouch secured with Velcro fasteners on the upper or lower leg. The bag can be emptied via a valve.

Thanks to a multi-chamber system, modern urine bags remain relatively flat even when full and are therefore inconspicuous. This allows patients to maintain their ability to participate in normal daily life, as well as their mobility and ability to work, with almost no restrictions. However, patients should avoid participating in sports while wearing the nephrostomy catheter. Another potential drawback is that certain movements or physical activities may remain restricted.

 

Illustration of the nephrostomy catheter and the correct way to wear the urine bag

Blockages of the urinary tract caused by kidney stones can usually be cleared relatively quickly. In this case, a temporary nephrostomy is the ideal solution. If, on the other hand, there is a long-term problem with the kidney, ureter, or bladder, a permanent solution is recommended once the situation has stabilized. The nephrostomy catheter is not durable enough to serve as a permanent replacement for the bladder.

Problematic narrowings of the ureter are kept open by internally supporting the ureteral lumen with a plastic scaffold, known as a stent. If sections of the ureter had to be removed, ureteral reconstructions using small strips of the bladder wall are now possible.

In cases of loss of bladder function and removal of the bladder, the creation of an artificial urinary opening (urostomy) is an alternative to permanent nephrostomy. To achieve this, the ends of one or both ureters can be sutured to the abdominal wall either directly (ureterocutaneous diversion) or via a segment of the intestine that has been rendered non-functional (conduit). In these cases, a urine bag is still required; however, the urostomy is more mechanically resilient than the nephrostomy catheter. Alternatively, certain amounts of urine can be stored in a so-called neobladder constructed from a segment of intestine.

If the kidney is already severely damaged due to hydronephrosis or disease, removal of the organ along with the ureter may be considered, provided that the second kidney is still intact.