Nephrostomy - Procedure and Complications

What Is Nephrostomy?

A nephrostomy is a surgical procedure in which an opening is made between the kidneys and the skin to divert the urine flow. Nephrostomy and urostomy are related procedures as both of them aim to divert the urine flow. A thin tube known as the nephrostomy tube is inserted through the opening into the kidneys. The tube reaches the point where the urine gets collected and finally drains the urine that is blocked. A nephrostomy procedure is specifically done for people suffering from cancer and having a blockage in the urinary system due to ureters, bladder, and urethra.

What Is a Urinary Tract?

The urinary tract or the renal system consists of organs forming and transporting urine outside the body. The organs are connected with the help of tubes and are further connected to the digestive system and the blood vessels. The body derives energy from food to carry out daily activities. After the body has used the food products, unused ones are left as waste in the blood and the bowel. The urinary system filters blood, and the waste products are separated and converted to urine. The major component of urine is urea, formed due to amino acid metabolism. The urinary system also maintains the body's fluid volume by controlling the amount of water excreted in the urine.

What Is a Nephrostomy Tube?

A nephrostomy tube or a nephrostomy catheter drains the urine directly from the kidneys to the bag attached outside the body. The tube mainly runs from the kidneys to a small cut made on the skin. A valve or a stopcock connects the nephrostomy tube to the drainage bag that collects the urine. It is an outpatient procedure where the patient can go home the same day after the treatment is complete. Sometimes, the doctor might recommend that the patient stays in the hospital for a few days to get some extra medical care and attention.

Why Should the Patient Undergo the Nephrostomy Procedure?

The patient might need to undergo a nephrostomy if he has been diagnosed with urethral or ovarian cancer or if cancer has blocked the passage of urine from the urinary tract. For example, if the ureters become blocked, the urine accumulates in the kidneys leading to swelling or build-up of pressure. As a result, the kidneys stop working suddenly. If the problem is left untreated for a long time, the patient might feel unwell. The patient might require one or two nephrostomy tubes depending on the number of ureters blockage. The procedure is known as bilateral nephrostomy if the patient requires two nephrostomy tubes. The following cancers are more likely to block the ureters:

• Bladder cancer.

• Colon cancer.

• Uterine cancer.

• Rectal cancer.

• Cervical cancer.

• Ovarian cancer.

• Prostate cancer.

How Should the Patient Prepare for the Nephrostomy Procedure?

The patient might be instructed about the following:

1. The patient must carefully understand the procedure from the doctor before undergoing it. In addition, he also needs to sign a consent form.

2. The doctor might order a blood test for the patient before the procedure to get an insight into his general health.

3. Metformin must not be taken prior to nephrostomy.

4. The patient might be administered a laxative before nephrostomy.

What Happens During a Nephrostomy?

A nephrostomy is usually done under local anesthesia, and the patient might stay in the hospital for some time. The doctor will perform an ultrasound or abdominal X-ray before the procedure. The procedure gets completed in 30 to 60 minutes. The recommended steps of the procedure are listed below:

• The patient must remove the ornaments and clothing as they might interfere with the procedure.

• A tube or an IV (intravenous) line is attached to the arm of the patient.

• When the area becomes numb, the doctor inserts a fine needle into the kidneys through the skin.

• Next, they insert a guide wire through the needle to place the nephrostomy tube into the kidneys.

• After the tube has been inserted, the doctors use sutures or stitches to keep the tube in place.

• The nephrostomy tube also has a locking mechanism that coils inside the kidneys to keep the tube in place.

• The doctor connects the tube to the drainage bag outside the body, which collects urine.

What Happens After the Nephrostomy Procedure?

After the procedure, the patient is asked to rest in the recovery room. The patient's blood pressure, pulse, and respiratory rate are continuously monitored. The patient might experience pain while passing urine. Hematuria, or blood in the urine, is also seen for a few days. Then, the nurse will check whether or not the nephrostomy tube is draining the urine properly.

How Should the Patient Take Care of Himself After the Procedure?

The nephrostomy tube will be present on the side of the patient’s back. The patient wears the bag under the clothes, and the bag remains attached to the thighs. The most important point is that the bag must be lower than the kidneys to facilitate urine drainage. Once the patient reaches home, he might be unable to go out or do his daily activities. Therefore, he must avoid activities that involve sudden movements. For example, he might feel pain bending or climbing the stairs, but he must follow the below-mentioned instructions:

• Change the nephrostomy bag frequently or when it is one-third to one-half full.

• Wash hands before and after changing the bag and dressing.

• Drink a sufficient quantity of water daily to flush out the bacteria from the urinary tract.

What Are the Complications of Nephrostomy?

The complications of nephrostomy are listed below:

• Bleeding.

• Urinary tract infections.

• Allergic reactions.

• Urinary incontinence or leakage of urine.

• Failed nephrostomy.

• Blockage in the nephrostomy tube.

• Radiation exposure.

Conclusion:

Nephrostomy is a simple procedure that is often considered similar to urostomy because it helps divert the urine flow. This procedure is a boon for patients suffering from urologic problems in which they cannot pass urine due to obstructed ureters, bladder, or urethra. It is the first line of treatment done in patients suffering from ovarian or urethral cancer. The patient might experience problems with the nephrostomy tube initially. Still, once he becomes used to the tube and follows the doctor’s instructions, the patient can do his routine activities easily. Consult the doctor to know more about the nephrostomy procedure.