Nephrostomy and ureteral stent procedure

A percutaneous nephrstomy is a soft flexible tube placed across the skin into the kidney that permits the drainage of urine into an external drainage bag. The ureter is the structure that connects the kidney to the bladder. A ureteral stent is a plastic tube that allows for drainage of the kidney into the bladder bypassing a blockage.

Conditions treated

A percutaneous nephrostomy or ureteral stent is typically placed when the drainage for the kidney is blocked. A blocked kidney can result in pain, risk of infection, and risk of kidney damage. Conditions that can cause blockage of the kidney may be due to stones, cancer or tumors, blood clots in the tubes that drain the kidney, or as result of anatomical abnormalities that prevent the easy drainage of urine from the kidney.

Sometimes your child's doctor may ask for a percutaneous nephrostomy tube or an ureteral stent to be placed prior to a planned surgical treatment involving the kidney or bladder, such as kidney stone removal.

The treatment process

The procedure typically requires 60 minutes to perform. Typically, sedation or anesthesia will be used to help facilitate the successful completion of the procedure. This helps to minimize anxiety for the child and decrease risk of complications as a result of movement during the procedure.

• The child will be positioned on the imaging table.
• The imaging technique usually starts with an ultrasound to identify the kidney that is blocked and dilated with urine.
• The skin surface will be cleaned to allow for a sterile skin puncture site.
• Local anesthetic will be introduced to help with comfort at the expected skin puncture site prior to a small skin nick is made to permit insertion of the needle into the kidney.
• A sample of urine will be obtained and sent to determine if an infection is present.
• A wire will be passed through the needle into the dilated collecting system of the kidney briefly using X-rays.
• The wire will serve as a path to place the nephrostomy tube or a ureteral stent into the correct position within the kidney collecting system or ureter.
• Contrast may be injected to identify the level of blockage of the kidney or ureter.
• The tube will then be secured into place and connected to a drainage bag to collect the urine or allowed to drain inside to the bladder if a ureteral stent is placed.

Recovery process

Your child may have some soreness at the site of insertion. Typically this can be well-controlled with ibuprofen or Tylenol.

Your child can generally sit in bed, a chair, or walk with the tube in place following the procedure. They may have some soreness at the insertion site that can be treated with pain medication if needed.

The drain will need to remain in place until the kidney is able to drain appropriately.

It is not unusual to have some blood in the urine following the procedure. This will typically clear over a day or two.

Benefits of treatment

• No surgical incision is required—only a small skin nick is made at the site for needle puncture. There is no need to have a stitch to close the skin puncture.
• The recovery period is usually faster than after open surgical drainage.
• Percutaneous nephrostomy tube placement procedures can permit rapid relief of the kidney blockage.

Risks of treatment

• Any procedure where the skin is penetrated carries a potential risk of infection. The chance of developing an infection that requires added antibiotic treatment appears to be less than one in 1,000.
• Very rarely, an adjacent organ may be injured by placement of a percutaneous nephrostomy tube.
• Rarely significant bleeding may occur.
• The drainage catheter placed for percutaneous nephrostomy may become blocked or displaced requiring adjustment or changing of the catheter.
• Rarely the kidney itself can be damaged as result of placing the tube through the kidney.
• Urine can leak around the catheter if the tube becomes blocked.