A nephrostomy tube is placed when there is an obstruction in the kidney, ureter, or bladder. The obstruction prevents normal internal drainage of urine from the kidney to the bladder. This can result in a severe infection and/or decrease function of the kidney itself. The obstruction can be from an infection, a stone, a narrowing of the ureter, or cancer.
A small skin nick is made at the puncture site to facilitate passage of the needle into the kidney. The needle is angled toward a posterior lower-pole or middle-pole calyx under ultrasound/xray guidance. If the collecting system is not dilated, intravenous (IV) administration of contrast medium may be required to achieve adequate visualization of the target. Once the needle is inserted into the calyx and into the collecting system, the stylet is removed, and urine is returned if an obstruction is present. A thin wire is then passed into the kidney. The access tract is dilated and the nephrostomy tube is inserted into the kidney. The nephrostomy tube is then sutured in place and connected to a drainage bag or clamped – depending on the patient’s condition.
Many times these nephrostomy tubes are placed for long term conditions. These tubes will need to be exchanged every 8-12 weeks. Removal of the nephrostomy tubes can be performed dependent upon the patient's underlying condition.