A Nephrostomy is a procedure where a small, flexible drain is placed directly through your back into your kidney. This allows urine to flow out of your body into a small collection bag when the normal path is blocked.
Common Indications for Nephrostomy
Your doctor may urgently request this if you have:
- A severe blockage in your ureter (the tube connecting the kidney to the bladder) caused by kidney stones, tumors, or scar tissue.
- A serious kidney infection trapped behind a blockage.
- Failing kidneys that need to be drained immediately to recover.
What happens during the procedure?
You will lie flat on your stomach. Using ultrasound and X-ray imaging, the radiologist finds the exact location of your kidney. The skin on your back is numbed, and you will receive relaxing IV medicine. The doctor guides a fine needle into the kidney, followed by a thin plastic tube. The tube is secured to your skin and connected to a drainage bag.
How do I care for the tube at home?
- Keep the bag lower than your kidneys at all times to prevent urine from backing up.
- Gently clean the skin around the tube every day with soap and water.
- Keep the dressing dry and change it regularly as instructed.
- Never pull on the tube.
- Empty the bag before it gets completely full.
What signs mean I should call my doctor?
Contact your medical team right away if:
- The tube stops draining urine or starts leaking onto your skin — this means it may be blocked or dislodged.
- You develop a fever, chills, or new flank pain — these are signs of infection.
What are the important limitations and safety checks?
Interventional radiology is minimally invasive, but it is not risk-free and is not automatically safer or more effective than surgery, endoscopy, medicines, or observation for every patient. Technical success does not always produce symptom relief or cure disease, and repeat treatment or another approach may be needed. Suitability depends on anatomy, disease severity, comorbidities, imaging, local expertise, and the alternatives available.
Risks vary by procedure and may include pain, bleeding, infection, contrast reaction, kidney injury, radiation exposure, vessel or organ injury, clotting, device movement or blockage, sedation complications, treatment failure, and an unplanned operation or admission. Tissue sampling can be nondiagnostic and requires pathology; tumor treatments require oncology follow-up. The consent discussion should cover the patient-specific benefits, material risks, alternatives, and what happens if the procedure cannot be completed.
Preparation is individualized. Give the team a complete list of anticoagulants, antiplatelet drugs, diabetes medicines, supplements, allergies, kidney problems, pregnancy possibility, and prior contrast reactions. Do not stop a blood thinner or diabetes medicine on your own: the procedural team and prescribing clinician must balance bleeding against thrombosis or metabolic risk and provide exact written instructions. Fasting, laboratory tests, antibiotics, sedation, escort, admission, and aftercare differ by procedure.
Know the urgent warning signs
After an IR procedure, seek urgent help for uncontrolled bleeding, fainting, chest pain, severe breathlessness, new weakness or confusion, a cold or very painful limb, fever or rigors, rapidly worsening pain or swelling, or a drain or tube that stops working, leaks, breaks, or comes out. Use the procedure-specific discharge instructions and emergency contact number.
Questions to ask the interventional-radiology team
- What is the goal, expected benefit, chance of needing another treatment, and reasonable alternative—including doing nothing for now?
- Who will perform the procedure, what image guidance and anesthesia or sedation will be used, and what experience does the center have with it?
- What exact medicine, fasting, blood-test, contrast, kidney, pregnancy, infection, transport, and overnight-stay instructions apply to me?
- What device or wound care is required, which symptoms are an emergency, and whom can I contact day and night?
- How and when will technical success, pathology, symptom response, and longer-term outcomes be assessed?
Sources and further reading
- CIRSE: Interventional-radiology procedures
- CIRSE: Clinical Practice Manual
- American College of Radiology: Manual on Contrast Media
Conclusion
A nephrostomy can decompress an obstructed collecting system, but kidney recovery and infection control are not guaranteed. Fever, rigors, worsening flank pain, heavy bleeding, no urine output, leakage, or displacement needs urgent assessment; flushing, exchange, and definitive treatment of the obstruction require a documented plan.