When a kidney becomes blocked and urine cannot drain normally toward the bladder, physicians sometimes recommend a procedure called percutaneous nephrostomy to relieve the obstruction. This article offers a general educational overview of what the procedure involves and why it may be recommended.
What Does "Percutaneous Nephrostomy" Mean?
The term breaks down into its parts: "percutaneous" means through the skin, and "nephrostomy" refers to an opening created into the kidney. Put together, percutaneous nephrostomy is a procedure in which a thin catheter is placed through the skin of the back directly into the kidney's collecting system, allowing urine to drain externally into a collection bag when the normal pathway to the bladder is blocked.
Why Might a Physician Recommend This Procedure?
Physicians typically consider percutaneous nephrostomy when the kidney is obstructed and urgent or temporary drainage is needed. Common underlying causes include:
- Kidney stones blocking the ureter
- Ureteral strictures narrowing the urinary pathway
- Tumors compressing or invading the ureter
- Post-surgical complications affecting urine flow
- Infection combined with obstruction, which can represent a more urgent clinical situation
In some cases, nephrostomy is used as a temporary bridge before a more definitive procedure, such as stone treatment or reconstructive surgery. In others, it may serve as a longer-term drainage solution when other options are not appropriate for a particular patient.
How Is the Procedure Generally Performed?
Percutaneous nephrostomy is typically performed using imaging guidance — such as ultrasound or fluoroscopy — to help the physician safely access the renal collecting system through the skin of the back or flank. A needle is used to gain initial access, over which a guidewire and then a catheter (often with a pigtail-shaped retention tip) are advanced into position. The catheter is then secured and connected to an external drainage bag.
This procedure is generally performed by an interventional radiologist or urologist, often under local anesthesia with sedation, though the specific approach depends on the clinical situation and institutional practice.
What Does the Nephrostomy Catheter Itself Look Like?
Nephrostomy catheters are typically made from soft, biocompatible materials such as polyurethane, and many feature a self-retaining pigtail (curled) tip designed to help keep the catheter positioned within the renal pelvis. Radiopacity is a common design feature, allowing the catheter's position to be confirmed under imaging both during placement and at follow-up.
What Are General Risks and Considerations?
As with any invasive procedure, percutaneous nephrostomy carries potential risks, which may include bleeding, infection, catheter blockage or dislodgement, or injury to nearby structures. A physician evaluates individual suitability and discusses relevant risks and alternatives before the procedure. Ongoing catheter care is also an important part of the process and is typically reviewed with the patient or caregiver in detail.
Frequently Asked Questions
Is percutaneous nephrostomy a permanent solution?
It can be either temporary or longer-term, depending on the underlying cause of obstruction and the overall treatment plan determined by the physician.
Does the procedure require general anesthesia?
Many nephrostomy procedures are performed under local anesthesia with sedation, though the specific anesthesia plan depends on the clinical situation and should be discussed with the care team beforehand.
What is the difference between a nephrostomy tube and a ureteral stent?
Both support urine drainage, but a nephrostomy tube exits through the skin and drains externally, while a ureteral stent is fully internal, draining urine from the kidney into the bladder. A physician determines which is appropriate based on the clinical scenario.
Related INVAMED Resources
- Double-J Stent vs Nephrostomy Tube: Key Differences
- Percutaneous Nephrostomy Kits: A Clinician's Guide
- Urology & Incontinence Management products
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