What is nephrostomy?

Cancers treated:
Ovarian cancer, cervical cancer, colorectal cancer, and other cancers of the pelvic area

Why performed: Tumors may cause a blockage of one or both of the ureters, the tubes that normally carry urine from the kidneys to the bladder. The blockage causes a backup of urine into the kidneys, creating a great risk of infection and kidney damage that cannot be repaired. The insertion of nephrostomy tubes prevents the backup of urine. Nephrostomy tubes may also be placed during a diagnostic procedure called an antegrade pyelogram, which is done to determine the location of the blockage. In some cases, the nephrostomy tubes are inserted to allow the placement of anticancer drugs directly into the kidney. Nephrostomy tubes are also used for other conditions that affect the urinary tract.

Patient preparation: Nephrostomy is usually performed on hospitalized patients. Some patients may have the procedure done without admission to a hospital. Preparation for the procedure may vary depending on the patient’s condition, the physician’s practice, and the facility. Generally, the patient must not have anything to eat or any opaque fluids to drink for six to eight hours before the procedure; clear, nonalcoholic fluids may be consumed up until a few hours ahead. The physician may ask the patient to temporarily stop or adjust the dose of some medications, including aspirin, blood thinners, and diabetes medications. Laboratory tests such as a complete blood count (CBC), coagulation tests, urinalysis, and urine culture for bacteria may be done before the procedure. The physician discusses the procedure, including the type of local anesthetic used, sedation, risks, and aftercare. The patient gives the physician permission to perform the procedure by reading and signing a consent form. Before signing the form, the patient may ask the physician questions to clarify anything that the doctor has said or any part of the consent form that the patient does not understand.

Steps of the procedure: An intravenous (IV) line is inserted, usually in the patient’s arm or hand, to provide fluids, antibiotics, pain medication, and sedation. Nephrostomy is generally performed in the interventional radiology department by an interventional radiologist or urologist. The patient lies on the stomach and remains awake, although medication is given that may cause drowsiness. Monitoring of blood pressure, heart rate, and oxygen level is done throughout the procedure. Imaging procedures, such as ultrasound, computed tomography (CT), or fluoroscopy, are used to visualize the area. These procedures are done before and during insertion of the nephrostomy tube to guide the physician in placing the tube.

The site where the tube will be inserted is sterilized. A medication such as lidocaine (Xylocaine) is given to numb the skin and tissues. A small incision is made, and a needle is inserted into the kidney. Contrast dye is injected for visualization, and the nephrostomy tube is inserted. The needle is removed. A dressing is placed over the site, and the nephrostomy tube is connected to a drainage bag. The tube site is on the right or left side of the back near the waistline, depending on which kidney is blocked. If both kidneys are blocked, then the physician will insert tubes for each kidney.

After the procedure: The patient is taken to the recovery room or back to the hospital room. A nurse will monitor the patient for any changes in blood pressure, heart rate, or breathing. The nurse monitors the urine output by measuring the urine collected in the bag. The bag may be attached to the patient’s leg by use of straps that are provided. Before discharge, the physician and/or a nurse will give the patient instructions on caring for the nephrostomy site, emptying the bag, monitoring the urine output, and noting signs of complications. Patients may need others to assist them in caring for the site and emptying the bag once they are home. In addition to the urine drained through the nephrostomy tube, the patient will still need to urinate. If only one tube is placed but the other kidney works normally, then the urine from that kidney still passes into the bladder. If nephrostomy tubes are placed in both kidneys, then there may still be drainage of some urine into the bladder.

Risks: The risks of nephrostomy include bleeding, infection, blood clots in the nephrostomy tube or bladder, and dislodgement of the nephrostomy tube. Pain at the catheter site may also occur.

Results: The placement of nephrostomy tubes will alleviate the backup of urine in the kidneys or allow treatment to be given. Although their use is normally for a short time, in some cases the blockage cannot be removed and the nephrostomy tubes remain in use permanently. In these cases, the tubes are replaced periodically.

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