A nephrostomy is a tube that’s 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.
The urinary system is made up of several different parts including the kidneys, the 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’s stored. When you’re ready to pass urine, it leaves the bladder through a tube called the urethra. The urethra opens immediately in front of the vagina in women and at the tip of the penis in men.
What is a nephrostomy?
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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, which can happen due to 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. You may still pass urine in a normal way even when you have a nephrostomy tube in one, or both, of your kidneys.
When a nephrostomy is needed
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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 from the kidney to the bladder, which causes urine to build up in the kidney. When this happens the kidneys can’t work properly and they may gradually stop working. This can make you feel very unwell unless it’s treated immediately. You may need one nephrostomy tube or two 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 a cancer of the bladder, cervix, womb or ovaries. In men, it may be a cancer of the prostate or bladder. In both men and women, it may be a cancer of the colon or rectum. Occasionally, a cancer that started in another part of the body spreads to the pelvis and blocks one or both ureters. You'll 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'll be asked to sign a form giving your permission (consent) to have the procedure. 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.
How long a nephrostomy tube stays in for
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Your doctor will explain how long you’re likely to have the nephrostomy tube in for. It 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 in the ureter. If the stent is successful the nephrostomy tube can be removed.
For some people it may not be suitable to have treatment or a stent put in. In this case, the nephrostomy will be permanent.
How a nephrostomy is done
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A nephrostomy tube is usually put in under local anaesthetic during a short stay in hospital. The procedure is done by a radiologist - a doctor who specialises in diagnosing and treating disease using x-rays and scans. It’s usually done in the x-ray (radiology) department as the doctor will use x-ray or an ultrasound scanning to guide them as they place the nephrostomy tube in the kidney. It can take up to 1-2 hours.
Before the procedure, 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. Through the cannula, you may be given intravenous antibiotics to reduce the risk of getting an infection. You may also be given a sedative to help you relax.
You’ll usually be asked to lie flat on your stomach on an x-ray table. When you’re comfortably positioned, the doctor will inject some local anaesthetic into the skin on the side of your back. Once the area is numb the doctor gently inserts a fine needle into the kidney and then puts a guidewire through the needle. The doctor uses the guidewire to place the nephrostomy tube in the correct position in the kidney. The tube is kept securely in place with stitches so it won’t come out and is connected to a bag outside the body that collects the urine.
When the nephrostomy tube is being put into the kidney it may hurt a little for a short time. You may be given a painkiller through the cannula in your arm. Remember to let the doctor or nurse know if you’re in any pain or feeling anxious.
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 the nephrostomy is draining urine properly and they’ll also monitor your blood pressure, pulse and temperature. Sometimes the doctor will check the position of the tube in the kidney. This is done by injecting a dye (called a contrast) into the tube which shows up on an x-ray.
You'll probably have some blood in your urine (haematuria) for the first couple of days after the nephrostomy is put in. The area where the tube was inserted may be uncomfortable so you’ll be given painkillers regularly for the pain. This usually settles down after a week or so and you’ll be given painkillers to take at home.
Possible complications from having a nephrostomy
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The risk of developing complications from having a nephrostomy is low. Possible complications are infection, bleeding from the kidney, or urine leaking from the kidney and collecting in the abdomen.
You'll be monitored very closely so that any problems can be picked up and treated straight away.
Looking after a nephrostomy
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Your nephrostomy tube will be stitched in place and will exit the skin from the side of your back. The tube will be attached to a drainage bag, which is usually worn under your clothing and is strapped to your thigh.
While you’re in hospital, the nurses will check the tube and empty the bag regularly. They’ll change the dressing as needed and show you how to empty the drainage bag and attach a new one to the end of the nephrostomy tube. The drainage bag 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.
Before you go home, the nurses will give you advice on how to look after and cope with your nephrostomy. They should tell you about showering and what activities you can or can’t do while you have your nephrostomy. They’ll arrange for a district nurse to check the tube, change your dressing and make sure you have enough drainage bags. You may decide to change the dressings yourself. Your nurse can show you how to do this. It may help to have a relative or close friend there as well in case you have any difficulties when you get home.
Coping at home with a nephrostomy
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Once you’re home you will be able to go out and about with your nephrostomy tube but you’ll need to avoid sudden movements that may tug on the tube. At first, bending or climbing stairs may be a bit uncomfortable and 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.
It’s natural to feel worried about coping with a nephrostomy at home. It may seem difficult in the beginning, but with help and support, people usually get used to it. Here are some important things to remember:
Change the bags as often as your nurse or doctor has advised.
Always wash your hands before and after you change the bag or the dressings.
Contact your doctor immediately if there’s blood in your urine, if it looks cloudy or smells strongly, or if it’s painful when you pass urine the normal way. You may have a urinary infection that will need to be treated with antibiotics.
Drink plenty of fluids. Aim to drink at least two litres per day (around four pints) to help reduce the risk of infection.
Contact your doctor or specialist nurse immediately if the area around the tube becomes uncomfortable, looks red or swollen, or feels warm. These may be signs of an infection, which will need to be treated immediately.
If the tube comes out, which is unusual, or if it stops draining urine, get in touch with your doctor or nurse straight away.
If you’re worried that something may be wrong with the nephrostomy, you should contact your doctor or nurse immediately.
Your feelings about having a nephrostomy
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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 over time. If you find 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 information has been compiled using a number of reliable sources, including:
DeVita, et al. Cancer – Principles and Practice of Oncology. 8th edition. Lippincott Williams and Wilkins. 2008.
Nariculam J, et al. Nephrostomy insertion for patients with bilateral ureteric obstruction caused by prostate cancer. The British Journal of Radiology. 2009. 0: 38306763 v1.
Nargund VH, et al. Urological Oncology. Springer. 2008.
Song Y, et al. Percutaneous nephrostomy versus indwelling ureteral stent in the management of gynecological malignancies. International journal of Gynaecological Cancer. 2012. 22, 4 pp697-702.
With thanks to Mr Vinod H. Nargund, Consultant Urological Surgeon, and the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices network.