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A nephrostomy is used to drain urine from the kidney into a bag outside the body. It helps to relieve a build-up of urine in the kidney, caused by a blockage.
A nephrostomy is a thin plastic tube (catheter) that is inserted through the skin on your back and into your kidney. It can relieve a build-up of urine in the kidney, and prevent 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. You may still pass urine in a normal way even when you have a nephrostomy tube in each of your kidneys.
The kidneys sit at the back of the body, one on each side, just underneath the ribcage. They filter 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’s stored until you are ready to pass urine.
The position of the kidneys, ureters and bladder View a large version of the diagram of the position of the kidneys, ureters and bladder|
People with cancer may need a nephrostomy if the cancer is blocking one, or both, ureters. If a ureter becomes blocked, urine can’t flow through the ureter into the bladder, which causes urine to build-up in the kidney. When this happens the kidneys can’t work properly. This can make you feel very unwell unless it’s treated immediately. You may need one nephrostomy tube or two, one for each of your kidneys, depending on whether one or both ureters are blocked.
Your ureters are more likely to become blocked if you have a cancer that started in the lower tummy (pelvis) and has spread within that area. For example, in women this may be cancer of the bladder|, cervix|, womb| or ovaries|. In men, it may be cancer of the prostate| or bladder. Occasionally, a cancer which started in another part of the body spreads to the pelvis and blocks one or both ureters. You will usually have a scan to find out exactly where the blockage is.
Before you have a nephrostomy, your doctor will explain its aims to you and the possible side effects or complications. You will be asked to sign a form saying that you give your permission (consent) to have the procedure. No medical treatment can be given without your consent. Make sure you ask any questions you have and if there’s anything you don’t understand let the staff know so that they can explain. You may also want to talk things over with family or friends.
Your doctor will explain how long you’re likely to have the nephrostomy tube in for. This will depend on your individual situation. It will be removed if treatment for the cancer relieves the blockage. Sometimes a small tube called a stent is put through the blockage and if this is successful the nephrostomy can be removed.
For some people it may not be suitable to have treatment or a stent put in and the nephrostomy will be permanent.
A nephrostomy is usually put in under local anaesthetic during a short stay in hospital.
The procedure will be done by a radiologist, who is a doctor who specialises in diagnosing and treating disease using x-rays and scans. The procedure is usually done in the x-ray department and can take up to 1-2 hours.
You’ll have blood tests to find out how your kidneys are working and a fine tube (cannula) may be put into a vein in your arm. Sometimes a drip (infusion) is attached to the cannula to give you fluids. You may be given intravenous antibiotics (into the cannula in your arm) to reduce the risk of getting an infection. You may be given a sedative to help you to relax.
You’ll usually be asked to lie flat on your stomach. A nurse will help to make sure that you’re lying comfortably. To begin with, your doctor will inject some local anaesthetic into the skin on your back, at the side, to numb the area and the deeper tissues. The procedure is done using x-ray, ultrasound or a CT scan to give a picture of the kidney and to help guide the needle into the correct place.
The doctor will gently insert a fine guide wire to find the right position before putting in the nephrostomy tube. During the procedure you may have a painkiller through the cannula in your arm if you need it. When the nephrostomy tube is being put into the kidney it may hurt a little for a short time. Remember to let the doctor or nurse know if you’re in any pain or feeling anxious.
Once the tube is in the kidney it’s connected to a bag outside the body that collects the urine. The tube is kept securely in place with stitches so it won’t come out.
You’ll be looked after in a hospital ward and will usually need to stay in bed for a few hours or until the next day. The nurses will check that the nephrostomy is draining urine properly and they’ll monitor your blood pressure and pulse.
You’ll be given painkillers regularly, as the area where the tube was inserted may be uncomfortable. This usually settles down after a week or so and you’ll be given painkillers to take at home.
Sometimes the doctor checks the position of the tube in the kidney by injecting a dye, which shows up on x-ray, into it. You'll probably have some blood in your urine (haematuria) for the first couple of days after the nephrostomy is put in.
The risk of developing complications having a nephrostomy is low. Possible complications are infection, bleeding from the kidney, and urine leaking from the kidney and collecting in the abdomen.
You will be monitored very closely so that any problems can be picked up and treated straight away.
The nurses will check the tube and empty the bag regularly. They’ll change the dressing as needed and show you how to attach a drainage bag to the end of the nephrostomy. The bag is worn under your clothing and can be strapped onto your leg. It must always be kept at a level lower than the kidney. At night time you can attach a larger drainage bag to the nephrostomy tube.
You’ll have to be careful to avoid sudden movements that may tug on the tube, but it won’t stop you from getting around, or going out. Bending or climbing stairs may be a bit uncomfortable. It may feel more comfortable if you place your hand over the nephrostomy. It might take you a little while to get used to finding the most comfortable position to sleep in.
Before you go home, the nurses will give you advice on how to look after and cope with the nephrostomy. They’ll arrange for district nurses to check the tube, change your dressing and to make sure you have enough drainage bags. You may decide to change the dressings for yourself. Your nurse can show you how to do this. It could help to have a relative or close friend there as well in case you have any difficulties when you get home.
It’s natural to feel worried about coping with a nephrostomy at home. It may seem difficult to begin with but, with help and support, people usually gradually get used to it. Here are some important things to remember:
If you’re worried that something may be wrong with the nephrostomy, you should contact your doctor or nurse immediately.
Having a nephrostomy is a big change in your life and it may affect the way you feel about your body. Some people feel embarrassed and uncomfortable about their partner seeing it. These feelings are a natural part of learning to cope with a nephrostomy and usually decrease gradually over time. If you find that you’re still having problems coping, ask your GP or your hospital doctor for help.
Everyone has their own way of dealing with difficult situations and the feelings they experience. Some people find it helpful to talk things over with family and friends or their doctor or specialist nurse. Others may prefer to talk to a trained counsellor. Your doctor or nurse can give you more advice about this. You can also contact our cancer support specialists| to talk over your concerns and for information and support.
This section is based on our Nephrostomy factsheet which has been compiled using information from a number of reliable sources, including:
For further references, please see the general bibliography|.
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.