A nephrostomy tube is a thin, flexible catheter placed through the skin of the back directly into the kidney to drain urine. This medical device is necessary when the normal flow of urine from the kidney to the bladder is blocked, often due to kidney stones, infection, trauma, or tumors affecting the ureter. By diverting the urine to an external drainage bag, the tube prevents pressure buildup that can cause pain and potentially damage the kidney. Once the underlying obstruction is resolved and the kidney’s natural drainage pathway is restored, the nephrostomy tube is ready for removal.
Pre-Removal Criteria and Logistics
The decision to remove the tube requires confirmation that the initial medical problem is resolved and the kidney is draining properly into the bladder. This determination is made by a physician, often an interventional radiologist or urologist, using specialized imaging. A common pre-removal test is a nephrostogram, where contrast dye is injected through the tube to visualize the ureter and confirm it is patent, allowing urine to flow freely.
The removal must always be performed in a clinical setting, such as a hospital, outpatient clinic, or radiology suite. The procedure is carried out by a trained healthcare professional, including a physician, physician assistant, nurse practitioner, or registered nurse experienced in the technique. This controlled environment ensures immediate medical support is available if any unexpected complication occurs.
The nephrostomy tract (the tunnel of tissue surrounding the tube) must “mature,” forming a stable channel through the tissue layers. A mature tract allows the channel to close naturally and rapidly after the tube is withdrawn. The healthcare team confirms this maturity before scheduling removal to minimize prolonged leakage from the site.
The Nephrostomy Tube Removal Procedure
The removal procedure begins with the patient positioned, often lying on the side opposite the tube, to give the clinician clear access to the insertion site. The skin around the tube is cleansed with an antiseptic solution to maintain a sterile field. Although the procedure is quick, a local anesthetic may be injected near the skin opening to numb the area, though this is not always necessary.
The next step involves releasing the mechanism that holds the catheter inside the kidney. Tubes typically use one of two retention methods: a small, fluid-filled balloon or a curved “pigtail” loop. If the tube has a balloon, a syringe is attached to the external port, and the fluid (usually 2 to 10 milliliters of sterile water) is gently withdrawn to fully deflate it.
For a pigtail-style catheter, a locking suture or thread maintaining the coil inside the kidney must be cut or unlocked. Once the retention mechanism is disengaged, any external sutures or securing devices are cut and removed. The clinician then grasps the tube and uses a smooth, quick, controlled motion to withdraw the catheter completely.
Patients typically report feeling a sensation of mild pressure or a brief tugging as the tube slides out, which lasts only a few seconds. In some cases, a thin guide wire may be temporarily inserted through the tube just before removal to provide a path for immediate re-insertion if an unexpected problem were to arise. Once the tube is fully out, the clinician confirms that the entire catheter, including the retention tip, is intact and no fragments have been left behind within the kidney.
Post-Removal Care and Monitoring
Immediately following the tube’s removal, the clinician applies firm pressure to the insertion site for several minutes to help the tract seal and minimize bleeding. After pressure is maintained, a sterile dressing or bandage is applied over the small opening. This dressing protects the site from contamination while the natural healing process begins.
The nephrostomy tract is expected to close quickly, usually within a few hours or, at most, within a day. It is common for a small amount of urine or fluid to leak from the site initially, but this should decrease rapidly as the channel seals. The patient is instructed to keep the initial dressing clean and dry and to remove it approximately 24 hours after the procedure.
For the next 24 to 48 hours, patients should avoid heavy lifting and strenuous physical activities to ensure the tract heals smoothly. While showering is allowed after the initial 24 hours, it is necessary to keep the area dry and avoid submerging the wound in water—meaning no baths or swimming—for about one week to prevent the risk of infection.
Monitoring the site for signs of complications is an important part of the recovery process. The patient should watch for any persistent or significant leakage, increasing redness, or swelling around the former tube site. Urgent medical attention is required if the patient develops a fever over 100°F (38°C) or chills, experiences severe back or side pain, or notices a significant decrease in urine output. These symptoms could indicate an infection or a re-obstruction of the urinary pathway.