My Clinical Experience with Nephrostomy
Nephrostomy is one of the most critical procedures in urology: timely drainage of an obstructed, infected kidney saves lives. The procedure is fast, performed under local anesthesia with ultrasound guidance, and typically produces dramatic improvement in the patient’s condition within hours.
- Emergency drainage of obstructed/infected kidney (pyonephrosis).
- Local anesthesia — rapid placement in emergencies.
- Ultrasound ± fluoroscopic guidance for safe access.
- Bridge therapy before PCNL or other definitive treatment.
What is Nephrostomy (PCN)?
PCN (Percutaneous Nephrostomy) is the percutaneous placement of a thin catheter directly into the renal collecting system under imaging guidance. Purpose: diversion of urine externally, relief of pressure, drainage of pus, and protection of renal function.
Catheter 8–14 Fr
A thin pig-tail or Foley catheter is placed into the kidney. Replaced every 6–8 weeks to prevent blockage.
Ultrasound Guidance
Real-time ultrasound imaging for safe puncture of a dilated calyx. Fluoroscopy for position confirmation.
Not a Definitive Treatment
Nephrostomy is a bridge — it addresses the emergency need, not the underlying cause. Definitive treatment (PCNL, URS, tumor management) is performed at a later stage.
Indications & Emergencies
Obstructive UTI / Pyonephrosis
Obstructed + infected kidney = urological emergency. Immediate nephrostomy + IV antibiotics. Delay increases the risk of urosepsis.
Stone Obstruction with Urosepsis
Kidney stone obstructs the ureter + fever/septic signs: immediate nephrostomy or DJ stent. Nephrostomy is preferred when a DJ stent is not feasible or when there is risk of delay.
Bridge Before PCNL
Drainage for 2–4 weeks before PCNL: improves renal function, eliminates infection, reduces the risk of perioperative urosepsis.
Obstruction from Tumor
Extrinsic ureteral compression from malignancy (e.g., cervical, rectal, urothelial cancer): nephrostomy or DJ stent to preserve renal function while oncological therapy continues.
Emergency: Pus from the nephrostomy = pyonephrosis — urological emergency requiring immediate drainage and IV antibiotics. Do not delay contacting a urologist.
Before the Procedure
Imaging
CT or ultrasound to confirm hydronephrosis and identify the target calyx. Anatomical assessment for the optimal access route.
Blood Tests
INR/PTT, platelets, renal function. Correct coagulopathy if abnormal.
Antibiotics
In emergency drainage: IV antibiotics before the procedure. Culture of urine or pus from the nephrostomy immediately at placement.
How Nephrostomy Works
Anesthesia & Positioning
Local anesthesia (lidocaine) + IV analgesia/sedation. Patient in prone or lateral decubitus position.
Ultrasound Guidance
Real-time ultrasound imaging to locate the dilated calyx. Selection of the optimal entry point (posterior lower calyx for safety).
Needle & Guidewire
Seldinger 18G needle placed into the calyceal system. Aspiration of urine/pus (confirmation + culture). Guidewire inserted.
Catheter Placement
Channel dilation; 8–14 Fr pig-tail catheter placed. Fluoroscopic position confirmation. Catheter secured to the skin.
Anesthesia & Hospitalization
Nephrostomy Catheter Care
Entry Site Hygiene
Daily cleaning with antiseptic. Connection to a sterile drainage bag. Patient and caregiver education.
Hydration
>2 L/day to maintain urine flow and prevent catheter blockage.
Catheter Replacement
Every 6–8 weeks in the office or hospital. Emergency replacement if catheter becomes blocked or dislodged.
When to Contact Your Urologist
Fever, increased hematuria, cessation of drainage flow, or purulent fluid from the nephrostomy: contact your urologist IMMEDIATELY.
Nephrostomy vs DJ Stent
DJ Stent: Internal, Comfortable
Internal drainage device — no external catheter. Patient has no bag to manage. However: less effective in pyonephrosis or complete obstruction.
Nephrostomy: External, More Effective
Greater drainage flow. The urologist controls flow directly. Required when a DJ stent is not feasible or in pyonephrosis. Drawback: external catheter limits activities.
Clinical Decision
Emergency infection or pyonephrosis: nephrostomy first. Elective obstruction without infection: DJ stent often sufficient. Inability to achieve endoscopic access: nephrostomy.
Possible Complications
Bleeding (2–5%)
Most commonUsually mild — self-limiting. Severe bleeding (<1%): angiography/embolization.
Catheter Dislodgement (5–10%)
CommonPrompt replacement to avoid channel closure. Proper fixation reduces the risk.
Infection (2–5%)
SignificantProper catheter care + replacement every 6–8 weeks. Fever: contact your urologist.
Adjacent Organ Injury (<1%)
RareRibs, spleen, liver, bowel: rare with proper ultrasound guidance.
Frequently Asked Questions
What is a nephrostomy?
Nephrostomy (PCN — Percutaneous Nephrostomy) is the placement of a thin catheter directly into the kidney through the skin, under ultrasound and/or fluoroscopic guidance. Its purpose is immediate drainage of an obstructed kidney. The catheter diverts urine externally, relieving pressure and infection from the kidney.
When is a nephrostomy needed?
Emergency indications: (1) Obstructive urinary tract infection with risk of urosepsis (obstructed infected kidney — a urological emergency). (2) Pyonephrosis — pus in the kidney. (3) Uncontrolled renal colic pain from an obstruction that will not resolve. Elective indications: decompression before PCNL, obstruction from tumor or pregnancy.
Can nephrostomy be performed under local anesthesia?
Yes — nephrostomy is usually performed under local anesthesia with IV sedation/analgesia. In children or very anxious patients, general anesthesia may be used. In emergencies: minimal delay — local anesthesia allows rapid placement.
How long does the nephrostomy catheter stay in place?
It depends on the cause. For emergency drainage of a stone: remains until the stone is treated (PCNL, URS). Usually 1–4 weeks. For obstruction from a tumor: may remain permanently. Replaced every 6–8 weeks to avoid blockage or catheter-related infection.
What is pyonephrosis and why is it urgent?
Pyonephrosis is a collection of pus in the renal collecting system caused by an obstructed infection. Without immediate drainage, the kidney is destroyed and the patient risks developing urosepsis or septic shock. Nephrostomy = emergency drainage + IV antibiotics.
How does nephrostomy differ from a DJ stent?
Nephrostomy: an external catheter — diverts urine outside the body. Placed percutaneously. DJ stent (double-J): internal — placed endoscopically via the urethra, drains urine from the kidney into the bladder. Nephrostomy is preferred when a DJ stent is not possible (high obstruction, anatomical difficulties, or the need to control drainage directly).
What complications can occur after nephrostomy?
Bleeding (2–3%): usually mild, self-limiting. Catheter displacement or dislodgement: managed with replacement. Infection around the catheter: prevented with proper care. Rare: injury to adjacent organs.
Does nephrostomy require hospitalization?
In emergencies (pyonephrosis, urosepsis): hospitalization is required for IV antibiotics. For planned placements: outpatient or 1-day admission. Patient education for home catheter care is essential.
Related Topics
Emergency or Appointment in Rhodes
Fever, renal colic, or an obstructed kidney? Contact us immediately for evaluation and drainage at our urology practice in Rhodes.
Bibliography & References
- EAU Guidelines on Urological Infections 2024 — uroweb.org
- EAU Guidelines on Urolithiasis 2024 — uroweb.org
- Ramchandani P, et al. Percutaneous Nephrostomy. Semin Intervent Radiol 2011;28:424–429.
- Pearle MS, et al. Medical Management of Kidney Stones: AUA Guideline. J Urol 2014;192:316–324.
Medical Author
Dr. Marinos Vasilas, Urologist – Andrologist
Dr. Marinos Vasilas performs nephrostomy in both emergency and elective settings, ensuring immediate decompression and protection of renal function.
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