Hydronephrosis is a condition characterized by the swelling of a kidney due to the accumulation of urine. This buildup occurs when the urinary tract is obstructed, preventing normal drainage. To alleviate the resulting pressure, a procedure known as a percutaneous nephrostomy is often performed. This involves creating an opening between the kidney and the skin to allow urine to be diverted externally.
The Role of Nephrostomy in Treating Hydronephrosis
Hydronephrosis can arise from various blockages within the urinary system. Common causes include kidney stones lodged in the ureter, the tube carrying urine from the kidney to the bladder. Tumors related to ovarian, colon, or prostate cancer can also compress the ureter. Other factors include an enlarged prostate, scar tissue from previous surgeries, or congenital conditions affecting the urinary tract.
When urine cannot drain properly, the pressure inside the kidney increases. If left untreated, this sustained pressure can cause significant pain and increase the risk of infection. Over time, it can lead to permanent kidney damage, impairing the organ’s ability to filter waste from the blood.
A nephrostomy serves as a temporary or long-term solution to bypass the obstruction. By inserting a thin tube directly into the kidney, an alternative pathway is created for urine to exit the body, which relieves pressure and prevents further damage. The procedure allows the kidney to function while doctors diagnose and treat the underlying cause of the blockage.
The Nephrostomy Placement Procedure
Before the procedure, patients are advised to fast for several hours and may need to adjust certain medications, like blood thinners, to reduce bleeding risks. Blood tests are conducted to assess kidney function and blood clotting factors.
The placement of a nephrostomy tube is performed by an interventional radiologist. Patients receive a local anesthetic to numb the skin on their back, along with sedation for comfort. The radiologist uses imaging guidance, such as ultrasound or a CT scan, to precisely locate the renal pelvis, which ensures accurate placement and minimizes risks.
Using imaging as a guide, the radiologist inserts a thin needle through the skin into the kidney. A guidewire is passed through the needle, which is then removed. The nephrostomy catheter, a flexible plastic tube, is advanced over the guidewire until it is positioned in the kidney’s collecting system. A contrast dye may be injected to confirm placement before it is secured.
Following the procedure, patients are monitored for a few hours to check vital signs and ensure the tube is draining effectively. The urine is collected in an external drainage bag, and the medical team provides instructions for at-home care.
Managing a Nephrostomy Tube
The dressing around the insertion site on the back must be kept clean and dry to reduce the risk of infection. The dressing is changed every few days, or more frequently if it becomes wet or soiled.
The drainage bag needs to be emptied regularly, when it is about two-thirds full. Keep the drainage bag positioned below the level of the kidney to ensure urine flows away from it and does not back up. The bag should be secured to the leg or clothing to prevent the tube from being accidentally pulled.
To prevent the tube from becoming clogged, it may need to be flushed with sterile saline. This is done one to three times per week, as determined by the healthcare provider. Patients or their caregivers will receive specific instructions on how to perform this flushing technique.
Daily activities may require some adjustments to accommodate the nephrostomy tube. Special precautions are needed when showering to keep the insertion site dry, often involving waterproof dressings. It is also important to be mindful of the tube while sleeping and dressing to avoid putting tension on it.
Potential Complications and When to Seek Help
Signs of an infection, such as a fever or chills, warrant immediate medical attention. Increased pain or redness at the insertion site can also indicate an infection or another issue.
If there is very little or no urine draining from the tube, it could signify a blockage. Urine leaking from around the insertion site is another sign that the tube may not be functioning correctly or has become dislodged.
If the nephrostomy tube accidentally falls out or becomes displaced, it is a medical emergency. The tract through the skin and into the kidney can begin to close quickly, making reinsertion difficult. In this situation, it is important to contact a healthcare provider immediately.