A nephrostomy lets urine drain from the kidney if there is a blockage in the urinary system.
People with cancer may need a nephrostomy if there is a blockage in the urinary system. A nephrostomy is an opening that is made between the kidney and the skin on your back. It lets urine drain from the kidney.
A thin, flexible tube (catheter) goes through the opening and into your kidney. This is called a nephrostomy tube. Urine drains through the tube into a 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.
The urinary system is made up of 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 bean-shaped. They are just above the level of the belly button. Kidneys filter your blood to get rid of waste products, and change them into urine (pee).
Urine travels from each kidney through a fine tube (ureter) to the bladder, where it is stored. The bladder is in the lower part of the tummy (abdomen). This area is called the pelvis. When you are ready to pass urine, it leaves the bladder through a tube called the urethra. The urethra opens in front of the vagina, or at the tip of the penis.
You may need a nephrostomy if the cancer, or cancer treatment, affects one or both ureters. If a ureter becomes blocked, urine cannot flow from the kidney to the bladder. This causes urine to build up in the kidney. When this happens, the kidney may slowly stop working.
If this is not treated quickly it can make you feel very unwell. You may need one nephrostomy tube or two, depending on whether one or both ureters are blocked. If you have one tube only, this is called a unilateral nephrostomy. If you have tubes in both ureters, this is called bilateral nephrostomies.
Cancers that start in the lower tummy (pelvis) are most likely to block the ureters. These include cancers of the:
Sometimes, a cancer that started in another part of the body spreads to the pelvis and forms a tumour. This can block one or both ureters. You usually have a scan to find out exactly where the blockage is.
Giving your consent
Before you have a nephrostomy, your doctor will explain what will happen and any possible side effects or complications. You will need to sign a form giving your permission (consent) to have the procedure. Ask them any questions you have and tell them if there is anything you do not understand.
You may also want to talk things over with your family or friends.
You may want to ask your doctor:
- Why do I need a nephrostomy?
- Is there a different treatment I could have instead?
- What would happen if I decided not to have a nephrostomy?
- How long will I be in hospital for?
- Who should I contact if I have problems with the nephrostomy?
Your doctor will explain how long you are likely to have a nephrostomy tube. They may remove it if treatment for the cancer clears the blockage. Sometimes, the doctor puts a tube called a stent into the ureter. The stent holds the ureter open so it is no longer blocked. This means the nephrostomy tube can be removed.
If cancer treatment or a stent does not clear the blockage, the nephrostomy tube is left in. The doctor replaces it every 3 to 4 months, to stop it from blocking. Replacing a nephrostomy tube is a very quick procedure.
You usually have a nephrostomy insertion done under local anaesthetic and during a short stay in hospital. A doctor usually does the procedure in the x-ray (radiology) department. The doctor, called a radiologist, uses x-rays and ultrasound scans to help them place the nephrostomy tube in the kidney. It can take 30 to 60 minutes.
Your doctor or nurse will put a fine tube (cannula) into a vein in your arm. They may use this to give you:
- a drip (infusion) of fluids
- antibiotics, to reduce your risk of getting an infection
- a sedative, to help you relax
You lie flat on your tummy on an x-ray table. When you are comfortable, the doctor injects some local anaesthetic into the skin on the side of your back.
When the area is numb, the doctor gently puts a fine needle through the skin and 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 kidney. They use stitches or dressings keep the tube in place.
The nephrostomy tube may also have a locking system. This coils inside the kidney to keep the tube in place. The doctor connects the tube to a drainage bag outside the body, which collects the urine.
You may feel discomfort when the doctor is putting the nephrostomy tube into the kidney. Tell them if you have any pain or feel anxious. They can give you a painkiller through the cannula in your arm.
You are looked after in a hospital ward and usually need to stay in bed for a few hours. The nurses will check the nephrostomy tube is draining urine. They will also check your blood pressure, pulse and temperature. Sometimes the doctor may do a test to check the position of the tube in the kidney. This is done by injecting a dye (called a contrast) into the tube. This shows up on an x-ray.
You may have some blood in your urine (haematuria) for about 2 days after the nephrostomy is put in. The area where the tube was put in may be uncomfortable. You will have regular painkillers. Any pain or discomfort usually gets better after about a week.
Possible complications from having a nephrostomy
The risk of complications from a nephrostomy is low. Possible complications include:
- bleeding from the kidney
- urine leaking from the kidney and collecting in the abdomen.
The doctors and nurses will check you regularly for any problems. This means if you have any, they can be treated straight away.
Before you go home
While you are in hospital, the nurses check the tube and empty the bag regularly. They will show you how to look after your nephrostomy. They can show you how to empty and change the drainage bag and will change the dressing. They will also tell you how long you need to wait before having a bath or shower.
You may decide to change the dressings yourself. Your nurse can show you how to do this. It may help to have a family member or close friend with you, so they can help when you get home.
The nurses in the hospital will arrange for you to see a practice nurse at your GP surgery, or for a district nurse to visit you at home. The practice nurse or district nurse will check the tube and change your dressing. They will also make sure you have enough drainage bags.
Before you go home, the nurse will tell you who to contact if you are worried that something is wrong with the nephrostomy. If the tube comes out, or if it stops draining urine, contact them straight away. You should also contact them straight away if:
- there is blood in your urine
- your urine looks cloudy or smells strongly
- it is painful when you pass urine in the normal way
- the area around the tube becomes uncomfortable, looks red or swollen, or feels warm.
These are all possible signs of an infection. You may need antibiotics.
Your nephrostomy tube will be at the side of your back. The tube is attached to a drainage bag. You usually wear the bag under your clothes and strap it to your thigh. Or you may have a bag that sticks to the skin directly over the tube.
It is important that you always keep the bag lower than the kidney. This helps the urine to drain. At night, you can attach a larger drainage bag that does not need emptying until the morning.
Once you are home, you will be able to go out as before. But, you should avoid sudden movements that may tug on the tube. At first, bending or climbing stairs may be uncomfortable. Place your hand over the nephrostomy when you need to move in a way that feels uncomfortable. This can help to prevent pulling on the tube. It might take you a little while to find 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.
- Drink plenty of fluids to help reduce the risk of infection. You should try to drink at least 2 litres (3½ pints) a day.
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 over time. If you find you are still having problems coping, ask your GP or your hospital doctor for help.
Everyone has their own way of dealing with difficult feelings. Some people find it helpful to talk to someone. This could be:
- a family member
- a friend
- your doctor
- your specialist nurse
- a trained counsellor (ask your doctor or nurse 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 7 days a week, 8am to 8pm for information and support.
Below is a sample of the sources used in our supportive treatment information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
The British Association of Urological Surgeons (BAUS). Percutaneous insertion of a nephrostomy tube. April 2017. Leaflet No:16/066. Available from http://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Percutaneous nephrostomy.pdf (accessed June 2019)
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.
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