Percutaneous Nephrostomy and/or Ureteric Stent Placement Patient information leaflet (199kB pdf)
Introduction
We hope this guide will answer your questions about your percutaneous nephrostomy
and/or uretic stent placement. Please contact the team if you require further information via the details at the end of this leaflet.
What is a percutaneous nephrostomy
and/or uretic stent placement?
A nephrostomy is a tube that is inserted using ultrasound and X-ray guidance through a small incision in the back to the central part of the kidney where urine collects. The tube drains urine to a bag and allows the kidney to work. If you have a kidney transplant the tube would be inserted in your front directly into the transplant kidney. A ureteric stent is a plastic tube which sits in the ureter with one end in the kidney and the other end in the bladder. This tube can be inserted through the back like a nephrostomy tube. If you have had surgery in the past to remove your bladder then sometimes a ureteric stent can be placed through an ileal conduit with one end through your stoma in the urine bag on your front and the other end in the kidney. The ureteric stent will usually remain in place until the underlying reason for blocked ureter is treated. Ureteric stents can remain in place for 3 to 6 months.
Why do I need a percutaneous nephrostomy
and/or uretic stent placement?
Urine normally drains from the kidney via a tube called the ureter into the bladder. If the ureter becomes blocked then the kidney cannot drain urine to the bladder and cannot function. Sometimes the urine built up in the kidney can become infected and make you very unwell. If the kidney remains blocked longer term then it will eventually stop working completely. The most common cause for blocked ureter is kidney stones. Sometimes the ureter can be blocked due to other causes like prostate cancer or bladder cancer. A nephrostomy drainage will relieve the symptoms of blockage and keep the kidney working.
What are the associated risks?
X-Ray radiation: All x-ray procedures involve exposure to radiation in varying amounts. The dose you get from a medical x-ray is very low and your doctor along with the radiologists have determined that the benefits of having the examination outweigh potential risks. The radiographer is present throughout your test making sure that the radiation dose is kept as low as reasonably possible and the duration and level of x-rays are kept to a minimum.
Contrast medium: A very small number of patients have an allergic reaction to the contrast medium (an iodine based solution often known as x-ray dye). This can be minor, severe, or even life threatening but the chances of this occurring are very rare. If you get an itchy rash or difficulty breathing during the procedure tell a member of staff, the team will provide appropriate treatment. Before your examination begins the radiographer will ask you a series of questions about your medical history, including any allergies you may have. This will help us assess if you are at risk of an allergic reaction to the x-ray dye.
Procedure: Nephrostomy is a very safe procedure, but as with any medical procedure there are some risks and complications that can arise. Serious risks associated with nephrostomy or ureteric stent insertion are rare. There is a small risk of the procedure itself causing a urine infection. This will happen to fewer than 1 in 100 people (less than 1%). The urine in the kidney may be infected. This can generally be treated satisfactorily with antibiotics, but occasionally you can feel unwell after the procedure. There is a small risk of causing bleeding from the kidney or structures next to the kidney. This will happen to fewer than 1 in 100 people (less than 1%). It is common for the urine to be bloody immediately after the procedure. This usually clears over the next 24–48hrs. Occasionally people can bleed more severely, in which case it may be necessary to do further imaging and procedures to stop the bleeding. On rare occasions, the bleeding may be more severe and require a transfusion. Very rarely the bleeding may require another surgical operation or radiological procedure to stop it. Sometimes there is a leak of urine from the kidney, resulting in a small collection of fluid inside the abdomen. If this becomes a large collection, it may require draining under local anaesthetic. Occasionally it might not be possible to place a nephrostomy or ureteric stent due to the anatomy of your kidney or ureter, in which case we would discuss other options with you. If this happens, you may require a small operation to overcome the blockage or a repeat procedure. Despite these possible complications, the procedure is normally very
Will I need an injection?
Occasionally, patients are given antibiotics, sedative and painkillers through a cannula placed in your arm.
Preparing for your procedure
A percutaneous nephrostomy is usually carried out as a day case procedure under local anaesthetic. You may receive a sedative to relieve anxiety, as well as an antibiotic. In case of admission, you are advised to bring an overnight bag with your personal toiletries. Please do not have anything to eat for 6 hours prior to your procedure. You may still drink clear fluids such as water. Please leave any jewellery or valuables at home. Please contact the booking team before your appointment if:
- you are or think you may be pregnant
- you have had a previous allergic reaction to contrast medium (X-ray dye) or are allergic to iodine.
- you weigh over 30 stone/190 kilograms
- you take metformin to manage your diabetes.
- you plan on using hospital transport or need a hoist to transfer
- you require an interpreter – please inform us as soon as you receive your appointment letter, and we will arrange an interpreter for you
If you are unsure or have questions about your preparation, contact your doctor or the X-ray department for advice.
Allergies
If you have asthma or any allergies, especially to iodine or X-ray contrast (CT or coronary angiogram dye), please inform us in advance.
Medication
If you are on anticoagulation (blood thinners) medications, you will be instructed to stop taking them for a period of time. You are advised to bring your regular medications with you.
Getting to us
Once you have arrived at The Princess Alexandra Hospital (Hamstel Road, Harlow, Essex,
CM20 1QX), follow the signage to the radiology reception, which is located on the ground floor, green zone. Please let the radiology receptionist know that you have arrived for your appointment.
When should I arrive?
Please arrive in the radiology department at your given appointment time. A notification
through text or letter should have been sent to you to confirm this appointment.
Can someone stay with me in hospital?
You may have a friend or relative attend with you, but they will be asked to stay in
the waiting area while you have your procedure.
Children are not allowed in the waiting area unattended. Our staff are not permitted to
supervise children, so please ensure child care arrangements are in place to avoid your
tests being rescheduled.
The day of the procedure
You will be shown to a cubicle and asked to undress and put on a gown; please bring a dressing gown if you have one. You may also be asked to remove jewellery, dentures, glasses, or other metal objects, which may show up on the X-rays.
The procedure
Your identification will be checked by a nurse and radiographer, a brief history will be taken; please tell the radiologist what medication, severe allergies, choking episodes or other medical conditions, such as thyroid disease and diabetes you may have. Before the procedure, the interventional radiologist will explain the procedure and ask you to sign a consent form. Please feel free to ask any questions that you may have and, remember that even at this stage, you can decide against going ahead with the procedure if you so wish. You will lie on the X-ray table, generally flat or nearly flat on your stomach. Occasionally a cushion is placed under your stomach. You may have monitoring devices attached to your chest and finger and will be given oxygen. The procedure is performed under sterile conditions and the interventional radiologist and radiology nurse will wear sterile gowns and gloves. A small cannula (thin tube) will be placed into a vein in your arm for antibiotics, sedative and painkillers to be given. Your skin will be swabbed with antiseptic skin preparation, and you will be covered with sterile drapes. The skin overlying the puncture site will be numbed with local anaesthetic. The interventional radiologist will use an ultrasound probe and the X-ray equipment to place a fine needle accurately into the kidney. When happy with the position, a guide wire will be inserted to allow the small plastic tube (catheter) to be placed. This catheter will then be fixed to the skin surface, and attached to a drainage bag.
After the procedure
You will be taken back to the ward. Nursing staff will carry out routine observations including pulse and blood pressure and will also check the treatment site. You will generally stay in bed for a couple of hours until you have recovered. The nephrostomy catheter remains in place in your body for the time being and will be attached to a collection bag. The drainage tube will remain in place for an amount of time determined by your doctor, and you will be given instructions about the proper care of the nephrostomy catheter when you go home. If a ureteric stent has been placed, a plan should be made for its removal or exchange after a period of time, usually six months, depending on why it was placed. You will be able to carry on a normal life with the catheter in place. The bag needs to be emptied fairly frequently, so that it does not become too heavy, but the nurses may wish to measure the amount in it each time. Take it easy for the rest of the day but you can resume normal activities the next day.
Can I drive after my procedure?
No, it is important that you have a responsible adult to escort you home. You must not drive or use public transport for the journey home.
How soon can I return to work?
It is recommended that you rest for the remainder of the day. Avoid heavy lifting and gym exercise. You can return back to work after 48 hours.
When will I get my results?
You will not know the results of your examination immediately. The radiologist will report their findings to the clinician who arranged your procedure, who will discuss the results with you. It usually takes a couple of weeks for the results to become available.
What do I do if I feel unwell after I have gone home?
You may have a small amount of bruising around the site of entry; however, if you notice any excessive bleeding you should call your GP, or go straight to the A&E department. If you experience a high temperature or fever, excessive pain, or diarrhoea you must contact your GP or the A&E department as you may have an infection which needs to be treated with antibiotics.
Contacting the team
- If you have any further questions about your procedure or an existing appointment, please contact the radiology department (Monday to Friday, 9am to 4pm) at 01279 82 2527 or 3405
- If you have any queries outside of working hours (after 4pm and on weekends), you will be redirected to the main radiology reception. Please note appointment bookings cannot be made during this time.
Your feedback matters
- If you would like to give feedback on your care, please contact our patient experience team at [email protected] or01279 827211.
- Please contact the communications team at [email protected] if you would like this leaflet in another language or format.