Background Information:

What are the other Names for the Procedure?

• Nephropyelostomy

What is the Percutaneous Nephrostomy surgical procedure?

• Nephrostomy is a surgical procedure wherein a tube which connects to the kidney is inserted through a skin incision
• Percutaneous means “through the skin” and nephrostomy means “opening in the kidney”

What part of the Body does the Procedure involve?

A Percutaneous Nephrostomy procedure involves the kidney and the ureter.

Why is the Percutaneous Nephrostomy surgical procedure Performed?

A Percutaneous Nephrostomy procedure is performed for the following reasons:

• To treat urinary obstruction
• To treat kidney stones: The tube can be used as an opening through which a surgical instrument can be used, in order to break kidney stones

What are some Alternative Choices for the Procedure?

• In case of urinary stones causing obstruction, extracorporeal shockwave lithotripsy (ESWL) may be used as an alternative to Percutaneous Nephrostomy technique to break the kidney stones
• ESWL involves producing shockwaves outside the body and using the waves to break up the stone into tiny particles, which is then passed out through the urine

What are the Recent Advances in the Procedure?

Use of fiber optic equipment is a major advancement in Percutaneous Nephrostomy procedure.

What is the Cost of performing the Percutaneous Nephrostomy surgical procedure?

The cost of Percutaneous Nephrostomy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding a Percutaneous Nephrostomy procedure and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006

http://www.surgeryencyclopedia.com/La-Pa/Nephrostomy.html (accessed on 06/19/2016)

Prior to Percutaneous Nephrostomy surgical procedure:

How is the Percutaneous Nephrostomy surgical procedure Performed?

• The Percutaneous Nephrostomy procedure may be performed under sedation and local anesthesia, to numb the surgical area over the lower back skin
• The surgeon inserts a needle into the kidney using an imaging modality, such as an ultrasound or CT, for guidance. The needle is placed in the required area to either facilitate urine drainage or break kidney stones
• A guide wire is then inserted through the needle up to the kidney, followed by a catheter, which is a hollow tube. The guide wire helps in proper positioning of the catheter and may be removed after catheter placement
• The catheter connects the kidney to a bag outside the body. This helps in urinary drainage

Where is the Procedure Performed?

A Percutaneous Nephrostomy procedure is typically performed in a hospital.

Who Performs the Procedure?

A general surgeon or an urologist performs a Percutaneous Nephrostomy surgical procedure.

How long will the Procedure take?

The Percutaneous Nephrostomy surgical procedure may be performed in 1-2 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Percutaneous Nephrostomy procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for the Percutaneous Nephrostomy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Percutaneous Nephrostomy surgical procedure?

Before a Percutaneous Nephrostomy surgical procedure, the patient has to undergo certain tests such as:

• Routine blood and urine analysis
• Ultrasound of abdomen
• Intravenous pyelogram (IVP)
• Computerized tomography (CT) scan
• Cystoscopy

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Percutaneous Nephrostomy surgical procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Percutaneous Nephrostomy surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia with sedation is administered during the Percutaneous Nephrostomy procedure.

How much Blood will you lose, during the Procedure?

An uncomplicated Percutaneous Nephrostomy procedure does not involve significant blood losses.

What are the possible Risks and Complications during the Percutaneous Nephrostomy surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
• Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders and chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Percutaneous Nephrostomy surgery include:

• Excessive bleeding
• Infection of the surgical wound
• Anesthetic complications
• Accidental injury to blood vessels or organs around the kidney

What Post-Operative Care is needed at the Healthcare Facility after the Percutaneous Nephrostomy surgical procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.

After the Percutaneous Nephrostomy surgical procedure:

What are the possible Risks and Complications after the Percutaneous Nephrostomy surgical procedure?

The possible risks and complications that may arise after Percutaneous Nephrostomy surgical procedure are:

• Excessive bleeding
• Infection in the surgical wound
• Formation of blood clots

What is the Prognosis after the Surgery?

The prognosis after a Percutaneous Nephrostomy procedure is usually excellent.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Worsening pain and swelling within the surgical wound
• Bleeding or fluid drainage from the surgical wound
• The occurrence of any symptom that causes uneasiness such as nausea, vomiting, constipation, or abnormal swelling
• Urine within the collection bag becomes red, cloudy, or has a foul odor
• Displacement of the catheter tube
• There is collection of only little urine within the collection bag
• Signs of an infection
• Dizziness
• Muscle aches, headache
• Fever, feeling sick
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Percutaneous Nephrostomy surgical procedure?

At home, the following post-operative care is recommended, after a Percutaneous Nephrostomy surgical procedure:

• Slowly resume regular/daily activities as early as possible, which aids in faster recovery
• Ensure that the nephrostomy catheter is kept dry
• Frequently change the dressing over the area
• Ensure that the drainage bag is not allowed to drag under its weight
• Complete the course of prescribed medication under advice of the physician
• Take stool softeners to prevent constipation
• Take antibiotic medication to help combat or prevent infection
• Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain
• Elevate legs while resting to prevent the formation of blood clots and reduce the possibility of swelling
• Avoid all activities that are physically strenuous for about 2 weeks, as advised by your physician
• Resume driving only 1 week after being discharged from the healthcare facility, or as advised by your physician
• Avoid sex till complete healing has taken place (under advise by the physician)

How long does it normally take to fully recover, from the Procedure?

It usually takes approximately 1-3 weeks to fully recover from the Percutaneous Nephrostomy surgical procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The procedure does not involve the surgical removal of any tissue. A urine sample may however be collected and sent for examination.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Percutaneous Nephrostomy surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• A hospital
• An anesthesiologist (if anesthesia was administered)
• A general surgeon or a urologist

The patient is advised to inquire and confirm the type of billing, before the Percutaneous Nephrostomy procedure is performed.

Helpful Peer-Reviewed Medical Articles:

Dyer, R. B., Regan, J. D., Kavanagh, P. V., Khatod, E. G., Chen, M. Y., & Zagoria, R. J. (2002). Percutaneous Nephrostomy with Extensions of the Technique: Step by Step 1. Radiographics, 22(3), 503-525.

Radecka, E., & Magnusson, A. (2004). Complications associated with percutaneous nephrostomies. A retrospective study. Acta Radiologica, 45(2), 184-188.

Wah, T. M., Weston, M. J., & Irving, H. C. (2004). Percutaneous nephrostomy insertion: outcome data from a propspective multi-operator study at a UK training centre. Clinical radiology, 59(3), 255-261.

Patel, U., & Hussain, F. F. (2004). Percutaneous Nephrostomy of Nondilated Renal Collecting Systems with Fluoroscopic Guidance: Technique and Results 1. Radiology, 233(1), 226-233.

Matlaga, B. R., Shah, O. D., Zagoria, R. J., Dyer, R. B., Streem, S. B., & Assimos, D. G. (2003). Computerized tomography guided access for percutaneous nephrostolithotomy. The Journal of urology, 170(1), 45-47.

Ramchandani, P., Cardella, J. F., Grassi, C. J., Roberts, A. C., Sacks, D., Schwartzberg, M. S., ... & SCVIR Standards of Practice Committee. (2001). Quality improvement guidelines for percutaneous nephrostomy. Journal of Vascular and Interventional Radiology, 12(11), 1247-1251.

Laurin, S., Sandström, S., & Ivarsson, H. (2000). Percutaneous nephrostomy in infants and children. Academic radiology, 7(7), 526-529.

Thanos, L., Mylona, S., Stroumpouli, E., Kalioras, V., Pomoni, M., & Batakis, N. (2006). Percutaneous CT-guided nephrostomy: a safe and quick alternative method in management of obstructive and nonobstructive uropathy. Journal of endourology, 20(7), 486-490.

LeMaitre, L., Mestdagh, P., Marecatix-Delomez, J., Valtille, P., Dubrulle, F., & Biserte, J. (2000). Percutaneous nephrostomy: placement under laser guidance and real-time CT fluoroscopy. European radiology, 10(6), 892-895.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA