Nephrostomy

The kidneys produce urine. Urine drains through the ureters into the bladder. It then passes through the urethra and leaves the body. Sometimes cancer in the lower abdomen can block one or both of the ureters. When this happens, urine can’t leave the kidney. This causes damage.

A nephrostomy allows urine to be drained through a tube. The tube is inserted through the skin on your back and into the kidney. Using an x-ray or ultrasound, your doctor will find the best place in the kidney to place the tube. The doctor numbs your back with a local anaesthetic and inserts a fine guide-wire into the kidney. The guide-wire helps the doctor place the nephrostomy tube correctly. Stitches or dressings hold the tube securely in place. The tube is connected to a urine collection bag which can be worn under your clothing. Your nurses will give you advice and support on looking after your nephrostomy.

Some people will need the nephrostomy for a short time. Others may need it permanently.

The urinary system

The urinary system is made up of several different parts. These include the kidneys, the ureters, the bladder and the urethra.

The kidneys are at the back of the body, one on each side, just underneath the ribcage. The kidneys are shaped like beans. They are positioned just above the level of the belly button. They filter your blood to get rid of waste products, which are changed into urine.

Urine is carried from each kidney through a fine tube (ureter) to the bladder, where it is stored. The bladder is positioned at the lower part of the abdomen. When you are 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.

Diagram showing the bladder and kidneys
Diagram showing the bladder and kidneys

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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. Some people may need a catheter into each kidney. The nephrostomy drains urine 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 some urine in a normal way even when you have a nephrostomy tube in one, or both, of your kidneys.


When a nephrostomy is needed

People with cancer may need a nephrostomy if the cancer affects one or both ureters. If a ureter becomes blocked, urine can’t flow from the kidney to the bladder. This 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 is treated quickly. 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 in that area. These include cancers of the:

Occasionally, a cancer that 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 what will happen and any possible side effects or complications. You will be asked to sign a form giving your permission (consent) to have the procedure. Make sure you ask questions and let the staff know if there is anything you do not understand. You may also want to talk things over with family or friends.


How long a nephrostomy tube stays in for

Your doctor will explain how long you are likely to have a nephrostomy tube. It may be removed if treatment for the cancer clears the blockage. Sometimes, a small tube called a stent is put through the blockage in the ureter. If the stent clears the blockage, the nephrostomy tube can be removed.

If cancer treatment or a stent does not clear the blockage, the nephrostomy will be left in.


How a nephrostomy is done

A nephrostomy tube is usually put in under local anaesthetic during a short stay in hospital. A doctor who specialises in using x-rays and scans (radiologist) does the procedure. It is usually done in the x-ray (radiology) department. The doctor will use x-ray or ultrasound scanning to help them place the nephrostomy tube in the kidney. It can take 30 to 60 minutes.

Your doctor or nurse may put a fine tube (cannula) into a vein in your arm. Sometimes a drip (infusion) is attached to the cannula to give you fluids. Your nurse or doctor may give you antibiotics through the cannula to reduce the risk of getting an infection. They may also give you a sedative to help you relax.

You will usually be asked to lie flat on your stomach on an x-ray table. When you are comfortable, the doctor will inject some local anaesthetic into the skin on the side of your back. When the area is numb, the doctor gently inserts a fine needle into the kidney. They then put a guide-wire through the needle. The doctor uses the guide-wire to place the nephrostomy tube in the correct position in the kidney. The tube is kept in place with stitches or dressings so it won’t come out. It may also have a locking system to keep it in place. The doctor will connect the tube 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 are in any pain or feeling anxious.


After the nephrostomy procedure

You will be looked after in a hospital ward and will usually need to stay in bed for a few hours. The nurses will check the nephrostomy is draining urine properly. They will 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 will 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 will be given regular painkillers. This usually settles down after a week or so.

Possible complications from having a nephrostomy

The risk of having any complications from a nephrostomy is low. Possible complications are:

  • infection
  • bleeding from the kidney
  • 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.


Looking after a nephrostomy

Your nephrostomy tube will come out from the side of your back. The tube will be attached to a drainage bag. The bag is usually worn under your clothes and is strapped to your thigh. Or you may have a bag that sticks to the skin directly over the tube.

While you are in hospital, the nurses will check the tube and empty the bag regularly. They will change the dressing and show you how to empty and change the drainage bag. The bag must always be kept at a level lower than the kidney to allow urine to drain easily. At night, you can attach a larger drainage bag that will not need emptying until the morning.

Before you go home, the nurses will give you advice on how to look after your nephrostomy. They will 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 so they can help when you get home.


Coping at home with a nephrostomy

Once you are home, you will be able to go out with your nephrostomy tube. You should avoid sudden movements that may tug on the tube. At first, bending or climbing stairs may be uncomfortable. It may help to place your hand over the nephrostomy when doing anything that feels uncomfortable. It might take you a little while to get used to finding the most comfortable position to sleep in.

It is natural to feel worried about coping with a nephrostomy at home. With help and support, people usually get used to it. Here are some important things to remember:

  • Change the bag 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 straight away if there is blood in your urine, if it looks cloudy or smells strongly, or if it is 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 (around four pints) a day to help reduce the risk of infection.
  • Contact your doctor or specialist nurse straight away 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 straight away.
  • If the tube comes out (which is unusual), or if it stops draining urine, contact your doctor or nurse straight away.
  • If you are worried that something may be wrong with the nephrostomy, you should contact your doctor or nurse straight away.


Your feelings about having a nephrostomy

Having a nephrostomy may affect the way you feel about your body (body image). Some people feel embarrassed and uncomfortable about other people seeing it. These feelings are a natural part of learning to cope with a nephrostomy. They usually get better. If you find you are still having problems coping, ask your GP or your hospital doctor for help. We can send you more information about body image.

Everyone has their own way of dealing with difficult feelings. 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.

Joining our online community can be a good way to meet people going through the same thing.

You can also contact our cancer support specialists on 0808 808 00 00 Monday to Friday, 9am to 8pm for information and support.

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