The urine from a normal kidney drains through a narrow, muscular tube, the urethra, into the bladder. When that tube becomes blocked, for example by a stone or a blood clot, the kidney can rapidly become affected, especially if there is infection present as well. While an operation may become necessary, it is also possible to relieve the blockage by inserting a fine plastic tube, called a catheter, through the skin, into the kidney, under local anaesthetic. This catheter then allows the urine to 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).
Who will be doing the percutaneous nephrostomy?
A specially trained doctor called a radiologist. Radiologists have special expertise in using x-ray and scanning equipment, and also in interpreting the images produced. They need to look at these images while carrying out the procedure. Consequently, radiologists are the best-trained people to insert needles and fine tubes into the body, through the skin, and place them correctly.
Where will the procedure take place?
Generally in the x-ray department, in a special “screening” room, which is adapted for specialized procedures.
How do I prepare for percutaneous nephrostomy?
You need to be an in-patient in the hospital. You will probably be asked not to eat for four hours beforehand, though you may be allowed to drink some water. You may receive a sedative to relieve anxiety, as well as an antibiotic. You will be asked to put on a hospital gown.
If you have any allergies, you must let your doctor know. If you have previously reacted to intravenous contrast medium, the dye used for kidney x-rays and CT scanning, then you must also tell your doctor about this.
What actually happens during a percutaneous nephrostomy?
You will lie on the x-ray table, generally flat on your stomach, or nearly flat. You need to have a needle put into a vein in your arm, so that the radiologist can give you a sedative or painkillers. Once in place, this needle does not cause any pain. You will also have a monitoring device attached to your chest and finger, and will probably receive oxygen through small tubes in your nose. The radiologist will keep everything as sterile as possible, and may wear a theatre gown and operating gloves. Your skin will be cleaned with antiseptic, and then most of the rest of your body covered with a theatre towel. The radiologist will use the x-ray equipment or the ultrasound machine to decide on the most suitable point for inserting the fine plastic tube (catheter), usually in your back, just below your bottom rib. Then your skin will be anaesthetised with local anaesthetic, and a fine needle inserted into the kidney.
When the radiologist is sure that the needle is in a satisfactory position, a guide wire will be placed into the kidney, through the needle, which then enables the plastic catheter to be positioned correctly. This catheter will then be fixed to the skin surface, and attached to a drainage bag.
Will it hurt?
Yes, it may hurt a little, for a very short period of time, but any pain you have should be controlled with painkillers. When the local anaesthetic is injected, it will sting to start with, but this soon wears off, and the skin and deeper tissues should then feel numb. Later, you may be aware of the needle and then the catheter passing into the kidney, and sometimes this is painful, especially if the kidney was sore to start with. There will be a nurse, or another member of clinical staff, standing next to you and looking after you.
If the procedure does become painful for you, then they will be able to arrange for you to have more painkillers through the needle in your arm. Generally, placing the catheter in the kidney only takes a short time, and once in place it should not hurt at all.
How long will it take?
Every patient’s situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be. It may be over in 20 minutes, or very occasionally it may take longer than
90 minutes. As a guide, expect to be in the x-ray department for about an hour altogether.
What happens afterwards?
You will be taken back to your ward on a trolley. Nurses on the ward will carry out routine observations, such as taking your pulse and blood pressure, to make sure that there are no problems. You will generally stay in bed for a few hours, until you have recovered.
The drainage catheter stays in place in your body for the time being, and will be attached to a collection bag. You will be able to carry on a normal life with the catheter in place. However, it is important that you try not to make any sudden movements, for example getting up out of a chair, without remembering about the bag, and making sure that it can move freely with you. The bag needs to be emptied fairly frequently, so that it does not become too heavy, but the nurses will want to measure the amount in it each time.
How long will the catheter stay in, and what happens next?
These are questions, which 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 period, to allow a more permanent solution for the blockage to be organized. Taking the catheter out does not hurt at all.
Are there any risks or complications?
Percutaneous nephrostomy is a very safe procedure, but there are some risks and complications that can arise, as with any medical treatment.
Perhaps the biggest problem is being unable to place the drainage tube satisfactorily in the kidney. If this happens, a surgeon will arrange another method of overcoming the blockage, which may involve surgery.
Sometimes there is a leak of urine from the kidney, resulting in a small collection of fluid inside the abdomen. If this becomes a large collection, it may require draining.
There may be slight bleeding from the kidney. On very rare occasions, this may become severe, and require a surgical operation or another radiological procedure to stop it.
Occasionally there may be infection in the kidney, or in the space around it. This can generally be treated satisfactorily with antibiotics.
Despite these possible complications, the procedure is normally very safe, and will almost certainly result in a great improvement in your medical condition. Very occasionally, an operation is required, but if the percutaneous nephrostomy had not been attempted, then this operation would have been necessary anyway.
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