Nephrostomy and ureteric stent insertion

Who has made the decision to place a nephrostomy or ureteric stent?

A urologist (a surgical doctor specialising in disorders of the kidney, ureter and bladder) will usually have made the decision based on information from previous scans you have had. A radiologist (x-ray doctor) will perform the procedure.

What is a Nephrostomy?

Urine normally drains from the kidney via a tube called the ureter into the bladder. If the ureter becomes blocked then the kidney cannot drain urine to the bladder and cannot function. Sometimes the urine built up in the kidney can become infected and make you very unwell. If the kidney remains blocked longer term then it will eventually stop working completely. The most common cause for blocked ureter is kidney stones. Sometimes the ureter can be blocked due to other causes like prostate cancer or bladder cancer.

A nephrostomy is a tube that is inserted using ultrasound and x-ray guidance through a small incision in the back to the central part of the kidney where urine collects. The tube drains urine to a bag and allows the kidney to work. If you have a kidney transplant the tube would be inserted in your front directly into the transplant kidney. 

What is a ureteric stent?

A ureteric stent is a plastic tube which sits in the ureter with one end in the kidney and the other end in the bladder. This tube can be inserted through the back like a nephrostomy tube. 

If you have had surgery in the past to remove your bladder then sometimes a ureteric stent can be placed through an ileal conduit with one end through your stoma in the urine bag on your front and the other end in the kidney. 

The ureteric stent will usually remain in place until the underlying reason for blocked ureter is treated. Ureteric stents can remain in place for three to six months. If there is a need for ureteric stents to be in place for longer than this then they would need to be replaced. Usually ureteric stents are replaced using a camera through the bladder by a urologist. 

Are there any alternatives to a nephrostomy or ureteric stent?

If the kidney is blocked and infected there is no effective alternative to a nephrostomy. 
If the kidney is blocked, but not infected a ureteric stent can sometimes be placed using a camera through the bladder by a urologist without needing to place a nephrostomy. Depending on the nature and location of blockage sometimes this is not possible in which case a ureteric stent can only be placed though a nephrostomy.  

A nephrostomy tube can be left in place without inserting a ureteric stent. A ureteric stent is generally preferred for longer term use as there is no need for a drainage bag, and a ureteric stent is less likely to become infected.

What are the risks with having a nephrostomy or ureteric stent inserted?

Serious risks associated with nephrostomy or ureteric stent insertion are rare.

  • The procedure will be done under local anaesthetic. It usually only causes mild discomfort but can occasionally be more painful. If you are in pain strong painkillers can be given directly into a vein to control the pain. 
  • Often the urine is infected before starting the procedure. There is a small risk (less than 1%) of the procedure itself causing a urine infection. This will happen to fewer than 1 in 100 people. Infection would be treated with antibiotics. 
  • Occasionally it might not be possible to place a nephrostomy or ureteric stent due to the anatomy of your kidney or ureter, in which case we would discuss other options with you.  
  • There is a small risk (less than 1%) of causing bleeding from the kidney or structures next to the kidney. This will happen to fewer than 1 in 100 people. The procedure is done under a combination of x-ray and ultrasound control to minimise this risk. A small amount of bleeding into the urine following the procedure is very common and is not serious. Occasionally people can bleed more severely, in which case it may be necessary to do further imaging and procedures to stop the bleeding. 

The procedure uses x-rays and the amount of radiation used is small, however if you think you may be pregnant please inform the Imaging department before attending the appointment.

What happens before the procedure?

  • You will need to have a blood test a few days before the procedure to check that you are not at increased risk of bleeding and that it will be safe to take the biopsy. This may be arranged to take place at your GP surgery.  
  • You can continue taking your normal medication. If you are on any medication which thins the blood (e.g. aspirin, clopidogrel, warfarin, rivaroxaban, dabigatran, apixaban) we ask you to call the interventional radiology department using the number on your appointment letter as we may need to adjust your medication before undergoing this procedure. If you are already an inpatient we will contact the ward to adjust your medication as necessary.

On the day of the procedure 

  • You should have nothing to eat but you may continue to drink water.
  • You will arrive at Gate 19 and be accompanied into our day case area. 
  • Please inform us if you have any allergies.
  • You will be asked to change into a hospital gown and a small plastic tube (venflon) may be put into a vein in your arm to allow us to administer medications or intravenous fluids during the procedure.
  • A radiologist will discuss the procedure with you. You will have an opportunity to ask questions about the procedure and your treatment. If you choose to have the procedure you will need to sign a consent form. 

During the procedure

  • We will go through a check list to confirm it is safe to proceed and you will be taken into an x-ray room. There will be a doctor, nurse and radiographer with you throughout the procedure.
  • You will be asked to lie on the x-ray table, normally on your front. Monitoring equipment will be attached to you so we can monitor your blood pressure, heart rate and oxygen levels throughout the procedure.
  • You will be awake throughout the procedure. 
  • Your skin will be cleaned with antiseptic solution and covered with sterile drapes.
  • If you are having a nephrostomy inserted then local anaesthetic will be injected into your back and access gained to the kidney using a needle. A nephrostomy tube or a ureteric stent will then be placed though this tract under x-ray guidance. 
  • If you already have a nephrostomy tube and are having a ureteric stent placed then the nephrostomy tube will be removed and the same tract used to place the ureteric stent. 
  • If you are in pain at any time during the procedure it is your responsibility to let the team looking after you aware so we can give you pain killers as required. 

What happens after the procedure?

  • You will usually stay in hospital overnight so we can monitor you. Occasionally depending on the exact procedure you have had done it may be possible for you to be discharged home the same day. 
  • You will be able to eat and drink as normal.
  • If you are a planned admission you will usually be able to go home the following day. If you are an emergency admission you will stay in hospital for a few days until you are well. 
  • Ureteric stents can stay in for up to six months. If you have not received an appointment for it to be removed or changed in six months’ time please contact your urologist.  
  • Nephrostomy tubes can stay in for up to three months.  If you have not received an appointment for it to be removed or changed in three months’ time please contact your urologist.

Finally we hope this information is helpful.  If you have any questions either before or after the procedure the staff in the interventional radiology department will be happy to answer them.

References

www.bsir.org/patients/nephrostomy/ - accessed July 2016

/www.bsir.org/patients/ureteric-stenting/ - accessed June 2017

How to contact us:

Southmead Hospital
Bristol BS10 5NB

www.nbt.nhs.uk

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

© North Bristol NHS Trust. This edition published February 2020. Review due February 2022. NBT003107

Nephrostomy and ureteric stent insertion