TRA — Nephrostomy and Ureteral Stent — TRA Medical Imaging provides interventional radiology services to Tacoma, Gig Harbor, Federal Way, Lakewood and other communities in the Pierce County / Puget Sound area of Washington state.

After Nephrostomy / external ureteral stent
Care and complications of the catheter site

Nephrostomy procedures involve insertion of a catheter (small tube) through the skin into the kidney to drain urine. These procedures can relieve urinary obstruction, divert urine and provide access for opening of clogged or narrowed structures within the kidney, bladder and urinary tract. In circumstances of ureteral narrowing (stricture) or tear of the ureter; placement of a ureteral stent (flexible tube) during nephrostomy can open a clogged ureter or bypass damaged structures allowing urine to drain.

Nephrostomy and ureteral stent may be necessary for patients whose normal urine drainage is compromised or occluded by renal stones, mass, edema (possibly post-surgical swelling), scarring, trauma or malignant encasement of the ureter.

Nephrostomy and ureteral stent procedures are performed on adults under conscious / IV sedation. General anesthesia is necessary to complete these procedures on newborns and small children.

For nephrostomy, the patient is usually positioned in a stomach or side lying position. The radiologist uses ultrasound guidance to locate the kidney and determine the site of entry (usually below the ribs from the back). The area is cleaned and shaved (if necessary). A local anesthetic, usually Lidocaine is injected to numb the skin and a small 1/4 inch incision is made. Under fluoroscopic x-ray guidance, a small hollow needle is inserted into the predetermined entry site. Next, a flexible guidewire is threaded through the needle and the needle is removed. A nephrostomy tube (draining catheter) is then placed over the guidewire, and the guidewire is removed leaving the catheter in place. Finally, a connecting tube is attached to the catheter and a urine collecting bag, which can be attached to the leg.

If ureteral stenting is necessary, one of two types of stent may be employed, an internal / external stent or an indwelling (internal) stent. An internal / external stent is easily replaced or removed. The indwelling stent is less of a burden to the patient (no external bag), however, replacement or removal requires a cystoscopy by an urologist or a repeat nephrostomy by the radiologist.

The internal / external stent can allow for bypass of the ureter while it heals from surgical repair or trauma. Internal / external stents are placed in the bladder via a kidney nephrostomy procedure with one end of the stent (catheter) emerging at the skin's surface. The stent is then capped.

The indwelling (internal) stent (flexible catheter) is also inserted via a kidney nephrostomy procedure, though, no external connection (bag) attached. The indwelling stent is placed in the bladder via the kidney. As a precaution for 1 to 2 days, a nephrostomy tube is secured on the skin with stitches for ready external access to the stent in case of occlusion. The tube is removed later leaving the internal stent in place.

Return to top

After Nephrostomy / external ureteral stent

Pain

Soreness may persist for 1 to 2 weeks after catheter is inserted and limit normal activity.
Patients should not take any aspirin-containing or blood thinning products while the catheter is in place. Tylenol can be taken for mild discomfort at the catheter site. If severe pain, swelling, leakage or redness occurs at the catheter site call the radiology specials department where the catheter was placed or treating physician.

Activity

Do not take a tub bath. Cover the dressing with plastic wrap before showering to ensure it does not get wet. A sponge bath is best.
Avoid any activity that causes a pulling sensation or pain around the catheter or twisting / kinking of the catheter.

Bruising / bleeding

It is common to see blood in the urine for 1 to 2 days after nephrostomy. This will clear up with regular irrigation (6 to 8 hour intervals) of the nephrostomy tube with sterile saline.

Return to top

Care and complications of the catheter site

It is important to keep the catheter site clean and dry, to maintain and change the urine collecting bag and to recognize signs of drain obstruction to include, fever, pain, decreased urine output or leakage of urine around the tube.
It is very important to keep appointments for nephrostomy changes (usually every 3 or 4 months).
Call your physician immediately if you have pain in your side, bleeding beyond 2 days of the catheter insertion, if your catheter leaks, falls out, breaks or becomes dislodged, if the skin around the catheter is red, swollen or has purulent discharge. Report any temperatures over 101 degrees (38.3 degrees Celsius).

Return to top

Interventional Radiology: Kidney, Bladder and Urinary Tract Nephrostomy and Ureteral Stent

Interventional Radiology: Kidney, Bladder and Urinary Tract
Nephrostomy and Ureteral Stent