Nephrostomy

This page explains about a nephrostomy and what to expect when your child comes to Great Ormond Street Hospital (GOSH) to have this procedure/treatment.

What is a nephrostomy?

Nephrostomy is a procedure which drains urine from a kidney using a thin, plastic tube called a nephrostomy tube or pig-tail catheter. The urine is collected in a special bag which needs be emptied regularly.

How does the urinary system work?

The urinary system consists of the kidneys, the bladder and ureters. The kidneys filter the blood to remove waste products and form urine. The urine flows from the kidneys down through the ureters to the bladder. From here it passes through another tube called the urethra to the outside when urinating (peeing).

What is a nephrostomy and why might your child need one?

When your child’s kidneys are working normally, urine goes from them into tubes called ureters, and then into the bladder. The urine is then passed out of the body by weeing.

If one of the ureters is blocked, for example by infection or a stone, the urine cannot drain away and puts pressure on the kidney. This can cause kidney failure if the blockage is not treated in time.

Nephrostomy is a procedure which drains urine from a kidney using a thin, plastic tube called a nephrostomy tube or pig-tail catheter. The urine is collected in a special bag which needs be emptied regularly.

The procedure is usually carried out in the Radiology Department by an interventional radiologist. They are specially trained doctors who use x-rays and other ways of looking inside the body to insert tiny tools to treat conditions, without needing a bigger operation.

Your child will be given a general anaesthetic so that they are deeply asleep and cannot feel pain. Your child may need to stay in hospital for a few days while any infection is treated and the reasons for the blockage are investigated.

What does it involve?

Once your child is under general anaesthetic, the doctor will use a variety of imaging techniques, such as ultrasound or x-rays, to guide them. Some local anaesthetic will be injected into the skin first, to make the area numb for a few hours.

Once the correct position has been confirmed, they will make a small incision (cut) through the skin and insert a thin plastic drainage tube. The free end of the tube is connected to a drainage bag to collect the fluid removed. The cut is closed around the tube with a small stitch to hold it in place and the area is covered with a large dressing.

Are there any risks?

All anaesthetics carry a risk, but this is extremely small. As well as the general anaesthetic, the radiologist will inject some long-acting local anaesthetic to stop pain in the area where the catheter will be.

The risk of infection is very small as there is no need to make any incisions or cuts. However, if your child does develop an infection, it can be easily treated with antibiotics.

There is a chance that your child could bleed from the place where the catheter was inserted, but this is very unusual. It is very normal for children to develop a bruise where the catheter was inserted or some blood in their urine (making it look pink) for a few days.

Your child may feel uncomfortable after the procedure, sometimes for up to a week, but pain relief like paracetamol or codeine is usually enough.

There is a chance that the radiologist will not be able to put the catheter in the right place for various reasons. If this happens, your child may need to have the blockage dealt with by another operation.

Sometimes, urine can leak out of the kidney and collect in the abdomen instead of passing into the catheter. If the amount of leakage is small, this should not cause too many problems, but your child may need a drainage tube from the abdomen if the amount increases.

There is a chance that the kidney will bleed during the procedure or soon afterwards. Again, if the amount of blood is small, this should not cause too many problems, but another operation is occasionally needed to deal with it if the amount increases.

Are there any alternatives?

No. The purpose of the operation is to quickly and safely drain the kidney of urine, and so reduce the risk of the kidney becoming seriously damaged. If urine is not drained from the kidneys, your child could develop kidney damage leading to kidney failure.

What happens before the procedure?

Your child may need to have a blood test to check everything is fine beforehand. The doctors will need to see you to explain the procedure in more detail, discuss any worries you might have and ask you to give your permission for the operation by signing a consent form.

If your child has any medical problems, such as allergies, please tell the doctors. An anaesthetist will also visit you to explain your child’s anaesthetic in more detail.

What happens afterwards?

Your child will return to the ward after they have recovered from the anaesthetic. After an anaesthetic, some children feel sick and may vomit. They may have a headache, sore throat or feel dizzy. These side effects don’t usually last long, are not severe, and are easily treated with medication.

Your child will be visited regularly by the medical team to check on their progress. They will check the urine for infection, and give antibiotics intravenously (into a vein) if necessary. Your child may be able to go home with the nephrostomy tubes in place, and ward staff will inform you if this is the case. Your child will then come back to the hospital for scans to see whether their kidney function is getting better.

When your child gets home

You should call the ward or your family doctor (GP) if you are worried, or if:

  • your child develops a fever
  • the urine draining from the tubes becomes more cloudy or smelly
  • your child is in a lot of pain and pain relief does not seem to help
  • the area where the catheter was inserted looks red, swollen and feels hotter than the surrounding skin
  • your child is not drinking any fluids after the first day back home
  • there is blood in your child’s urine
  • the catheter falls out or breaks

Coming back to hospital

Your child will need to come back to the hospital to check that everything is healing well and to plan further treatment if necessary. This could involve a short stay for further investigations and tests. We will let you know when to come back to the ward before you go home.

You should call the ward or your family doctor (GP) if

  • your child is in a lot of pain and pain relief does not seem to help
  • the wound site looks red, inflamed and feels hotter than the surrounding skin
  • there is any oozing from the wound
  • your child has a lot of blood in his or her urine
Compiled by: 
The Radiology department in collaboration with the Child and Family Information Group.
Last review date: 
September 2012
Ref: 
2012F0498

Disclaimer

Please note this is a generic GOSH information sheet. If you have specific questions about how this relates to your child, please ask your doctor. Please note this information may not necessarily reflect treatment at other hospitals.