Percutaneous Nephrostomy

The urine from a normal kidney drains through a narrow, muscular tube, the ureter, into the bladder.  Most people have 2 kidneys, one on the left side of the body & one on the right side. Sometimes the ureter tube can become obstructed by a kidney stone, mass or blood clot. If this happens, it can quickly affect the kidney, especially if there is infection as well. 

An operation may be needed.  However, it is also possible to clear the blockage under local anaesthetic.  A fine plastic tube, called a catheter, is passed through the skin into the kidney.  The urine will then drain from the kidney into a collecting bag, outside the body. 

This procedure is called a percutaneous (meaning through the skin) nephrostomy (a tube put into the kidney).

Other tests such as an ultrasound or CT scan will have shown that the tube leading from your kidney to the bladder is blocked.  However, it may not be obvious what has caused this.  If not treated, it will damage your kidney & the way it functions.

Your doctors and the radiologist will have discussed your case.  They will feel that this is the best option for you.   Your opinion will also be taken into account.  If, after discussion with your doctors, you do not want to have this done, you can decide against it.

A specially trained doctor called a radiologist.  Radiologists have special expertise in using imaging equipment, and interpreting the images produced.  They need to look at these images while carrying out the procedure.

They are therefore the best trained people to pass needles and fine tubes through the skin, and place them correctly.

Usually in the x-ray department, in a special "screening" room.  This is adapted for specialised procedures. 

It may be done in an operating theatre, using mobile x-ray equipment or a portable ultrasound scanner.

• you need to be an inpatient in the hospital for at least a full day
• you will be asked to put on a hospital gown
• you will probably be asked not to eat for four hours before the procedure
• you will be given a sedative to relieve anxiety & maybe also an antibiotic if there are signs of infection

You must tell your doctor if

• you have any allergies or take any medication to thin your blood such as Aspirin, Warfarin, Heparin, Apixaban or Clopidogrel
• you have ever had a reaction to intravenous contrast medium.  This is the dye used for kidney x-rays and CT scans

The radiologist will keep everything as sterile as possible.  They may wear a theatre gown and operating gloves. 

• you will lie on the x-ray table, usually flat on your stomach, or on your side
• a needle will be put into a vein in your arm.  This will be used by the anaesthetist to give you sedatives or painkillers.  The needle will not cause any pain
• a monitoring device will be attached to your chest and finger
• you will be given oxygen through small tubes in your nose or a mask
• your skin will be cleaned with antiseptic.  Most of the rest of your body will be covered with a theatre towel
• the radiologist will use the x-ray equipment & ultrasound machine to decide the most suitable point to put in the catheter.  This is usually in your back, just below your twelfth rib
• your skin will be anaesthetised with local anaesthetic. This will sting briefly but becomes numb very quickly. A needle will then be put into the kidney followed by a guidewire then catheter. The needle and guidewire are removed, only the catheter remains in place
• this will then be fixed to the skin surface, and attached to a drainage bag

Any pain you have should be controlled with painkillers.  If it is thought likely to cause more than a little pain, an anaesthetist will give you a sedative and intravenous painkillers.  A full anaesthetic is rarely needed.

When the local anaesthetic is injected, it will sting to start with.  This soon wears off.  The skin and deeper tissues should then feel numb very quickly. This will wear off after a few hours.

Later, you may feel the needle and then the catheter passing into the kidney.  This is more likely to be a dull pushing sensation & is not usually sore.

A nurse, or another member of clinical staff, will stand next to you to look after you.  If you do feel pain, he or she will arrange for you to have more painkillers.  These will be given through the needle in your arm. 

It will usually only take a short time to put in the catheter.  Once in place it should not hurt at all. 

It is different for each patient.  It is not always easy to tell how complex or how straight forward it will be.  It may be over in 20 minutes, but can take longer than 90 minutes.   As a guide, expect to be in the x-ray department for about 1 to 2 hours.

You will be taken back to your ward on a trolley. Nurses will take your pulse and blood pressure. This is to make sure there are no problems. You will stay in bed for a few hours, until you have recovered. At first the urine may be blood stained but this should clear over the next day or two. It helps if you are able to drink plenty of oral fluids to clear this. The staff looking after you will observe the urine output.

The catheter will stay in place for the time being. it will be attached to a collection bag. The collection bag can be attached to a belt which sits around your waist, this allows you to move about freely without having to carry the bag around. you will still be able to carry on a  normal life. However, it is important that you try to remember the bag when you move suddenly. For example getting up out of a chair. Always make sure that it can move freely with you.

The bag needs to be emptied fairly often, to stop it getting too heavy. The nurses may want to measure the amount in it each time. The ward staff & district nurses will help you to look after the bag & dressing. They will teach you how & when to empty the bag using a simple open/close valve.

These are questions only the doctors looking after you can answer.  It may only need to stay in a short time.  For example while a stone passes naturally.  Or, it may need to stay in for a much longer time.  The catheter may need to be replaced after around 12 weeks. This is usually a more straightforward procedure not needing admission to hospital or sedation. Taking the catheter out does not hurt at all.

This is considered to be very safe.  It will save you having a bigger operation.  There are some slight risks and possible complications involved, as with any medical treatment.  It is difficult to say exactly how often these happen.  However, they are usually minor and do not happen very often.

Perhaps the biggest problem is not being able to put the drainage tube in the kidney.  If this happens, a surgeon will arrange another way to treat the blockage.  This may mean having an operation.

There may be a leak of urine from the kidney.  This collects inside the abdomen.  If this is a large amount, it may need to be drained.

There may be some bleeding from the kidney.  Although very rare, this can be serious. An operation or another radiology procedure will then be needed to stop it.

The kidney, or the space around it, may be infected.  This can usually be treated with antibiotics.

Despite these possible complications, the procedure is normally very safe.  It will almost certainly result in a great improvement in your kidney function. 

Very occasionally, an operation is needed.  However, if the percutaneous nephrostomy had not been tried, this operation would have been needed anyway.

This leaflet should have answered some of your questions.  Remember though, that this is only a starting point for discussion.  Make sure you are satisfied that you have had enough information before you sign the consent form.

Further information

If you have any questions, you will be able to discuss these with the radiologist before the procedure.   You should discuss any other medical questions with your doctor.

If you have concerns you feel you must discuss before your appointment please telephone Radiology office (01896 826417).  Ask to arrange to speak to the consultant radiologist who will be performing the procedure. This may involve planning a time when you are both free to speak.