The Urinary System
The urinary system is made up of several different parts including the kidneys ureters the bladder and the urethra. The kidneys sit at the back of the body, one on each side, just underneath the ribcage. They filter your blood to remove waste products which they change into urine. Urine is carried from each kidney through a fine tube called a ureter to the bladder where it is stored. When you are ready to pass urine it leaves the bladder through a tube called the urethra.
What is a Nephrostomy
A Nephrostomy is a thin plastic tube (catheter) that is inserted through the skin on your back and into your kidney. It helps to relieve a build up of urine in the kidney, caused by
a blockage and prevents the kidney from being damaged. It drains urine directly from one or both kidneys into a collecting bag outside your body. The bag has a tap so you can empty it. Patients may still pass urine in the normal way even when they have a nephrostomy tube, in one or both of the kidneys.
Why is a Nephrostomy tube needed?
A nephrostomy tube is needed when the ureter (the tube that connects the kidney to the bladder) becomes blocked and urine cannot flow through from the kidney to the bladder. This can be caused by a stone, cancer growth or stricture (narrowing).
How long can my Nephrostomy stay in for?
The Doctor will explain how long the nephrostomy tube is likely to remain in place. It will depend on each patient’s individual situation. It will be removed if treatment can relieve the blockage for example with a stent. A stent is a specially designed hollow tube made of a flexible plastic material that is placed in the ureter (the tube that connects the kidney to the bladder).
However some patients are not suitable to have treatment or a stent and in these cases the nephrostomy will be permanent but will need to be changed periodically. The blockage may resolve on its own, or the patient may need to undergo treatment to relieve the blockage or the decision will be made to keep the nephrostomy permanently and a date arranged for admission to hospital for a change of nephrostomy tube or tubes.
Looking after a Nephrostomy
The nephrostomy tube will be stitched in place and will exit the skin from the side of the patients back. The tube will be attached to a drainage bag which is usually worn under your clothing and can either be strapped to the thigh or attached to an elastic belt. It is important NOT to leave the bag hanging as the weight of the urine and any tugging may cause the nephrostomy tube to fall out.
Nephrostomy Care
The skin around the nephrostomy tube insertion site should be kept clean and to prevent infection, place a sterile dressing around the site where the tube leaves the skin. The dressing should be changed at least once a week, especially if the dressing becomes wet. The drainage bag should be changed weekly.
Patients may shower and bathe 48 hours after the tube has been inserted but try to keep the tube site itself dry. Protect the skin with plastic wrap during showering or bathing. After 14 days the patient may shower without any protection for the tube.
Please remember to insure the tube is secure at all times. Swimming is not recommended as long as the tube is in place.
Possible Complications
The risks of developing complications from having a nephrostomy are low. Possible complications are infections, bleeding from the kidney or urine leaking from the kidney and collecting in the abdomen.
Signs & Symptoms
- Infections – The skin around the insertion site becomes red, hot and swollen.
- Blood in your urine, or it appears cloudy or smells strongly Bleeding from the kidney – Blood in the urine
- Urine collecting in the abdomen – the abdomen appears distended (swollen)
Are there any side effects?
Most procedures have a potential for side-effects. You should be reassured that, although all these complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.
Points of contact
The patient’s first point of call for advice should be the District Nurse/GP however if you have any other questions, or require more information please contact Urology One stop clinic via hospital switchboard. 01582 491166
Common (greater than 1 in 10)
- Minor bleeding from the kidney (visible in the urine drainage bag) Short lived discomfort in the kidney and at the insertion site
Occasional (between 1 in 10 and 1 in 50)
- Leakage of urine around the catheter inside the abdomen
- Blockage of the drainage tube
- Generalised infection following insertion – septicaemia (infection in the blood)
Rare (less than 1 in 50)
- Significant bleeding inside the abdomen requiring surgical drainage. Displacement of the drainage tube
- Failure to place the tube satisfactorily in the kidney requiring alternative treatment (e.g. surgical insertion of a drainage tube)
- Inadvertent damage to adjacent organs (e.g. stomach, bowel)