A nephrostomy is a small tube placed through the skin of your lower back directly into your kidney to drain urine. It’s used when urine can’t flow normally from the kidney to the bladder, usually because something is blocking the path. The tube bypasses the blockage entirely, channeling urine out of the kidney and into an external collection bag.
Why a Nephrostomy Is Needed
The three most common reasons for a blocked kidney in adults are kidney stones, cancer, and scar tissue (strictures) from previous surgery or injury. When urine backs up behind a blockage, pressure builds inside the kidney. Left untreated, this can cause severe pain, kidney infection, or permanent kidney damage.
A nephrostomy may be placed for several distinct purposes:
- Relieving obstruction: The most common reason. If a blockage causes infection, sudden kidney failure, or pain that won’t respond to medication, draining the kidney becomes urgent.
- Diverting urine: After a ureteral injury, bladder bleeding, or when a fistula (abnormal connection) develops between the urinary tract and another organ, a nephrostomy reroutes urine away from the problem area so it can heal.
- Providing access for other procedures: Surgeons sometimes use the tube’s pathway to remove stones, place stents, retrieve broken fragments of old stents, or deliver medication directly to the kidney.
- Diagnostic testing: In some cases, dye is injected through the tube to image the urinary tract or measure pressure inside the kidney.
How the Tube Is Placed
Nephrostomy placement is a minimally invasive procedure, typically performed by an interventional radiologist. You lie face down or slightly angled, and the doctor uses ultrasound or X-ray imaging to locate the kidney’s internal drainage system. After numbing the skin on your lower back, the doctor inserts a needle through the skin into a specific part of the kidney called a posterior calyx, chosen because it has fewer blood vessels and a safer angle of entry.
Once the needle reaches the kidney’s collecting system, a thin guidewire is threaded through it, and the needle is removed. The nephrostomy catheter slides over the wire and into position, with its tip sitting inside the kidney. The end of the tube has multiple small holes that allow urine (or pus, if infection is present) to flow freely into the drainage bag. The whole process generally takes under an hour, and most patients receive sedation along with local anesthesia rather than general anesthesia.
What Recovery Looks Like
Some blood-tinged urine is normal for the first few days after placement and usually clears on its own. Mild soreness around the insertion site is common. Most people go home the same day or the next morning, depending on the underlying condition that required the tube in the first place.
How long the tube stays in varies widely. For a temporary blockage like a kidney stone, it might be in place for days to a few weeks. When the cause is a tumor pressing on the ureter or a more complex surgical recovery, the nephrostomy may stay for months. Your doctor will determine when (or whether) it can be removed based on follow-up imaging showing the blockage has resolved.
Caring for the Tube at Home
Daily maintenance is straightforward but important. Clean the skin around the tube’s exit site with soap and water every day, and change the dressing roughly every three days or sooner if it gets wet or dirty.
The drainage bag needs to stay below your kidney level at all times to prevent urine from flowing backward. Empty it every two to three hours, or before it fills completely. If your care team says the bag is reusable, you can clean it with a mixture of two parts vinegar to three parts water, letting it soak for 20 minutes before air drying. Use a spare container to collect urine while the bag is being cleaned.
Your medical team will give you a schedule for tube exchanges, since nephrostomy catheters need periodic replacement to prevent buildup and blockage.
Possible Complications
Nephrostomy placement is generally safe. In one hospital study of 66 procedures, major complications occurred in about 4.5% of cases. The most significant risks include:
- Infection or septic shock: Occurred in roughly 3% of cases in that study. Bacteria can enter the bloodstream during or after the procedure, especially if the kidney was already infected. Symptoms include fever, chills, shaking (rigors), and a drop in blood pressure.
- Bleeding: Significant blood loss requiring transfusion happened in about 1.5% of cases. Some pink-tinged urine is expected, but heavy or pulsating bleeding can indicate damage to a blood vessel inside the kidney.
- Tube problems: Blockage, leaking, kinking, or cracking of the catheter affected about 6% of patients. These are typically manageable with a tube adjustment or replacement rather than a new procedure.
Warning Signs to Watch For
Once you’re home, certain symptoms mean the tube or the kidney needs immediate attention. Fever combined with flank pain is the classic warning of a kidney infection building behind the tube. Cloudy or foul-smelling drainage can signal the same thing. Chills, shaking, or feeling suddenly very unwell could indicate bacteria have entered the bloodstream.
If urine stops draining into the bag entirely, the tube may be blocked, kinked, or displaced. Increasing pain around the insertion site, significant swelling, or heavy bleeding from the site all warrant prompt medical evaluation. Light pink urine in the first few days is normal, but bright red urine or clots appearing after the initial recovery period are not.