A nephrostomy tube is a small, flexible catheter inserted through the skin on the back to drain urine directly from the kidney. This device is used when the normal pathway for urine—which flows from the kidney, down the ureter, and into the bladder—is blocked. The primary function of the tube is to relieve pressure within the kidney caused by urine backup, a condition known as hydronephrosis. By diverting the urine into an external drainage bag, the nephrostomy tube helps maintain kidney function and prevents further damage.
What is a Nephrostomy Tube and Its Primary Function
The nephrostomy tube is placed using imaging guidance, such as fluoroscopy or ultrasound, to ensure precise positioning. The tube traverses the back, passes through the kidney tissue, and terminates in the renal pelvis, the kidney’s collecting system. This minimally invasive procedure creates a bypass, allowing the kidney to empty safely when the ureter is obstructed.
Drainage is often required due to obstructions preventing urine flow. Common causes include kidney stones lodged in the ureter, scar tissue or strictures, or external compression from tumors. When acute obstruction combines with infection (obstructive pyelonephritis or urosepsis), tube placement is an urgent, potentially life-saving procedure to drain infected urine. The tube may also provide access for other procedures, such as breaking up large kidney stones.
Determining the Duration: Temporary, Long-Term, or Permanent Use
The duration a nephrostomy tube remains in place is determined entirely by the underlying medical condition. Most placements are intended to be temporary, serving as a short-term solution to relieve an acute blockage or to stabilize a patient before definitive treatment. For instance, a tube might be used for a few days to several weeks while a kidney stone passes or while awaiting surgery. Once the natural urinary tract flow is restored, the tube can be removed.
In other scenarios, the nephrostomy tube is required for long-term management, which is often mistakenly referred to as permanent. This long-term use occurs when the obstruction cannot be fully resolved due to chronic, irreversible conditions like advanced malignancy, severe scarring, or congenital anomalies. For patients receiving palliative care or those where corrective surgery is not an option, the tube provides continuous drainage indefinitely.
Even when used for a lifetime, the tube itself is not permanent and requires routine maintenance to function safely. Long-term placement is decided based on the inability to clear the blockage and the necessity of preserving kidney function.
Practical Management and the Removal Process
Living with a nephrostomy tube involves attention to daily care to prevent infection and blockage. The exit site on the back requires regular cleaning, typically with mild soap and water, and the dressing must be changed daily or whenever it becomes wet or soiled. The drainage bag, which collects the urine, must be kept below the kidney level to ensure continuous flow and should be emptied when it is about two-thirds full.
For tubes placed long-term, routine replacement is mandatory because the body naturally coats the catheter with mineral deposits and sediment from the urine. This build-up increases the risk of blockage and infection over time. Long-term nephrostomy tubes are therefore exchanged by a healthcare provider every two to three months to maintain drainage and prevent complications.
When a temporary tube is no longer needed because the obstruction has been cleared, the removal process is straightforward and quick. The physician simply removes the stitch securing the tube, and gently pulls the catheter out. This is usually an outpatient procedure that requires no significant recovery time, and the small tract where the tube exited the skin typically closes within a day.