How Is a Nephrostomy Tube Removed?

Removing a nephrostomy tube is usually a brief, bedside or clinic procedure that takes only a few minutes: the tube’s retention mechanism is released, the tube is pulled out through the skin in a single steady motion, and a dressing is applied over the site. Most people describe the sensation as uncomfortable pressure rather than sharp pain. What makes the process more involved is everything that happens around that quick pull, from the checks your medical team runs beforehand to the leakage and healing that follow over the next day or two.

Checks Your Team Runs Before Removal

A nephrostomy tube is placed through the skin of your back directly into the kidney to drain urine when the normal pathway is blocked. Because that blockage may or may not have resolved by the time removal is planned, your care team needs confirmation that urine can flow freely down to the bladder on its own before pulling the tube out. The classic way to check is an antegrade nephrostogram: contrast dye is injected through the tube under fluoroscopy (a live X-ray), and the team watches the dye travel from the kidney down the ureter into the bladder. If flow looks normal and there is no significant obstruction, removal gets the green light.

That fluoroscopic check works well but exposes you to radiation, so researchers have explored alternatives. One approach injects a small amount of methylene blue dye through the tube and then clamps it; if the blue dye appears in your bladder urine within a reasonable window, the pathway is open.¹ Another method measures the pressure inside the renal pelvis through the tube itself: if pressure stays at or below about 20 cm of water, the ureter is likely unobstructed and the tube can safely come out without needing fluoroscopy at all.² Neither radiation-free method has fully replaced the traditional nephrostogram everywhere, but they are increasingly available and can spare you the X-ray exposure.

In some cases, especially when the tube was placed after kidney stone surgery (percutaneous nephrolithotomy, or PCNL), the team may also do a brief “clamping trial.” The tube is clamped shut so urine has to find its way down through the ureter. If you tolerate the clamp without significant pain or fever over a period of hours, that is a strong signal the system is draining normally.

What the Actual Removal Feels Like

The physical removal itself is anticlimactic compared to the anxiety many people feel beforehand. Here is what typically happens step by step:

Positioning: You lie on your side or sit upright, depending on the tube’s location and your team’s preference. The skin around the tube’s exit site is cleaned.
Releasing the lock: Many nephrostomy tubes have a small loop or pigtail at the kidney end that keeps them from slipping out accidentally. The loop is straightened by pulling an internal locking string or deflating a small balloon, depending on the tube design.
Withdrawal: A clinician pulls the tube out in one smooth, steady motion. The whole extraction takes only a few seconds. You may feel a tugging sensation and brief burning at the skin exit point.
Dressing: A sterile gauze pad or adhesive dressing is placed over the site. That is it.

No stitches are placed. The tract that the tube created through your back muscle and kidney tissue is intended to close on its own. In most clinical settings this is done at the bedside or in an outpatient clinic, with no sedation needed. If you had the tube placed after stone surgery, removal often happens the day after the procedure, sometimes even in the operating room at the end of the surgery itself.

Why the Tract Leaks Afterward, and for How Long

The question nearly everyone asks after removal is: “How long will it leak?” The answer is usually measured in hours, not days. In one study tracking patients after PCNL, the median duration of urine leakage through the skin site was about 12 hours, with a range from as little as 3 hours to as long as 51 hours.³ That wide range reflects real individual variation. For most people, the tract seals within a day. But some leakage is nearly universal: one study found that roughly 70% of post-PCNL patients had some degree of urinary leakage through the exit site.⁴

The leakage is urine seeping out through the tunnel that the tube occupied. It is not a sign that something went wrong. You will likely need to change the dressing a few times and keep the area clean and dry. If leakage continues beyond about 48 hours, your team may place an internal stent (a thin tube running from the kidney to the bladder, entirely inside the body) to redirect urine flow and let the tract close.

Factors That Determine How Quickly the Site Seals

Several things influence whether your leakage resolves in a few hours or lingers for a couple of days:

Kidney swelling (hydronephrosis): If your kidney is still dilated at the time of removal, urine pressure is higher and the tract takes longer to seal. One study found that the degree of hydronephrosis was the single strongest predictor of prolonged leakage.³
Kidney tissue thickness: A thinner layer of kidney tissue (cortex) around the access tract correlates with longer leakage times, likely because there is less tissue to collapse and seal the tunnel.
Residual stones: Patients with leftover stone fragments leaked for a median of about 17 hours compared to 11 hours in those who were stone-free, a statistically meaningful difference.
Where the tube entered the kidney: Access through a middle or lower calyx (the cup-shaped structures inside the kidney) tends to produce more leakage than upper-calyx access.⁵
How long the tube was in place: Counterintuitively, keeping the nephrostomy tube in longer before removal was associated with more leakage, not less. Patients in the prolonged-leak group had their tubes in for an average of about 52 hours post-surgery, versus roughly 35 hours in the group that sealed quickly.

That last point is worth underscoring because many patients assume a longer “rest” with the tube in place gives the body more time to heal around it. The data suggest the opposite: a mature, well-established tract can actually be harder to close. This is one reason surgical teams have moved toward earlier removal.

Does Earlier Removal Lead to Better Outcomes?

There has been a clear trend toward removing nephrostomy tubes sooner rather than later after kidney stone surgery. A retrospective study comparing intraoperative removal (taking the tube out in the OR, immediately after surgery) to removal on the first postoperative day found striking differences. Postoperative fever occurred in about 1% of the intraoperative-removal group versus nearly 8% of those who kept the tube until the next day. Serious complications (rated grade 3 or higher on the Clavien-Dindo scale, meaning they required additional intervention) were dramatically less common with same-day removal: about 1% versus nearly 16%. Hospital stays were shorter too, with a median of 12 days versus 15.⁶

These findings do not mean every patient should have the tube yanked out on the operating table. The decision depends on whether stone clearance is complete, whether there is bleeding, and whether the ureter is clearly open. But when conditions are favorable, same-day removal appears to reduce infection risk and get patients home faster. If your surgeon recommends leaving the tube overnight or for an extra day, it is usually because one of those conditions has not been confirmed yet.

When the Tube Will Not Come Out Easily

Occasionally, removal is not the straightforward pull described above. The most common reason is encrustation: mineral deposits from urine build up on the tube’s surface, especially on the portion sitting inside the kidney. Over time, these deposits can harden enough to essentially cement the tube in place. In one case report, a patient’s nephrostomy tube became solidified within just five weeks, requiring multiple surgeries to address the encrustation, subsequent infections, and related complications.⁷

When a tube is encrusted, pulling harder is not the answer. One well-described technique involves threading a vascular sheath (a flexible outer tube) over the nephrostomy tube to dilate the tract and break up or bypass the mineral crust, allowing the encrusted tube to be withdrawn safely.⁸ In more severe cases, interventional radiologists or urologists may need to use endoscopic instruments to fragment the deposits before the tube can budge. The key takeaway for patients: if you have a nephrostomy tube, do not skip scheduled tube exchanges or follow-up appointments. Regular changes, typically every six to twelve weeks depending on the tube material and your urine chemistry, prevent encrustation from reaching the point where removal becomes a surgical challenge.

Rare but Real Complications

Significant complications from tube removal are uncommon, but they do occur. The most frequently cited concern is bleeding. The nephrostomy tract passes through the kidney’s outer tissue, which has a blood supply. In most patients, only minor oozing happens at the skin site after removal, but in rare cases a perirenal hematoma (a collection of blood around the kidney) can form. One documented case required CT imaging to define the hematoma’s extent, though it ultimately resolved with conservative management and no surgery.⁹

Other complications to be aware of include:

Infection: Bacteria can enter the tract during removal or in the hours afterward while the site is still open. Fever, chills, or worsening flank pain in the hours to days after removal warrant urgent medical contact.
Persistent urine leak: As discussed, most leakage resolves within a day. Leakage lasting beyond 48 hours sometimes requires placement of an internal ureteral stent or, rarely, a new nephrostomy tube.
Tract non-closure in thin kidneys: Patients with severely thinned kidney tissue from chronic obstruction or disease may take longer to seal the tract, and in very rare cases may need the tract closed with a small skin suture or tissue sealant.

For perspective, the vast majority of nephrostomy tube removals are uneventful. But knowing these possibilities helps you recognize warning signs early if they do occur.

Living with a Nephrostomy Tube While You Wait for Removal

For many patients, the harder part is not the removal itself but the days or weeks spent with the tube in place. Nephrostomy tubes typically connect to an external drainage bag, which you carry on your leg or hip. Showering is possible with waterproof dressings, but bathing and swimming are generally off-limits to avoid infection. The tube can cause a dull ache in the flank, and rolling onto it in bed at night is a common complaint. Accidental partial dislodgement, often from snagging the tube on clothing or furniture, can cause sudden pain and a burst of bloody drainage.

A few practical tips that tend to come up less often in formal discharge instructions: securing the tube to your skin with medical tape well away from the exit site reduces accidental pulls. Wearing a loose-fitting shirt that buttons or zips in front is easier than pulling something over your head. And keeping a spare dressing kit in your bag means you are not caught off guard if the dressing loosens while you are out.

If your tube is intended to stay in place long-term, as in cases of inoperable ureteral obstruction from cancer, regular exchange visits every two to three months are standard. The old tube is removed and a new one is placed through the same tract, usually under imaging guidance. Each exchange is essentially a mini version of the original placement procedure.

Nephrostomy Tubes Versus Internal Stents

Patients sometimes wonder why they received an external nephrostomy tube rather than an internal ureteral stent, which sits entirely inside the body and drains urine from the kidney to the bladder without any external hardware. The choice depends on the clinical situation. Nephrostomy tubes are preferred when the obstruction is at a level where a stent cannot pass (such as a completely blocked ureter), when the patient has an active infection that needs immediate external drainage, or when access to the ureter from below is not feasible. Internal stents are less disruptive to daily life and do not carry the same risk of accidental dislodgement, but they have their own downsides, including bladder irritation, frequent urination, and flank pain during voiding.

In some clinical pathways, a nephrostomy tube is placed first as emergency drainage, and later the team converts it to an internal stent once the acute problem (infection, stone, or swelling) has settled down. The nephrostomy tube then comes out following the steps described above, and the patient continues with only the internal stent, which is eventually removed via cystoscopy through the bladder. If your team discusses “converting to a stent,” this is the sequence they mean.

When a Tube Comes Out Accidentally

Unplanned tube dislodgement happens more often than people expect, especially during sleep or when changing clothes. What you should do depends on how long the tube has been in place. If the tube was recently placed (within the first week or so), the tract may not yet be mature enough to easily accept a replacement, and the situation is more urgent. If the tube has been in place for several weeks, the tract is well-formed and a new tube can typically be reinserted through the same path with relative ease.

In either case, the immediate steps are the same: cover the site with a clean dressing, note the time it came out, and contact your medical team. Do not attempt to push the tube back in yourself. If you were relying on the nephrostomy for drainage because your ureter is blocked, a dislodged tube can lead to urine backing up into the kidney, which may cause worsening pain, fever, or infection. This is one of those situations where same-day medical attention matters, even if you feel fine initially. Most interventional radiology departments have protocols for urgent tube reinsertion and can often fit you in the same day.