A nephrostomy is a simple, temporary way to drain blocked urine and protect the kidneys. It is used when urine cannot flow normally and restoring drainage reduces the risk of serious infection.
The procedure usually takes about 30–60 minutes and is performed in a radiology department by a specialist doctor. Imaging guidance helps improve safety and accuracy and success is often immediate once the tube drains.
This short guide gives clear information on what the procedure involves, why a person may need it, what happens in hospital, possible risks and what aftercare looks like at home. It signposts preparation steps, the type of sedation or anaesthetic that might be used, and what recovery feels like in the first few days.
Important safety message: worsening pain, heavy bleeding, fever or a stopped drainage bag can signal complications and should prompt urgent medical advice.
The article aims to help readers feel prepared and confident, while emphasising they must follow their doctor’s specific instructions and treatment plan. For related patient services and pre-operative guidance see a linked resource on fertility and care patient services and pre-operative support.
Key Takeaways
- A nephrostomy drains urine to protect kidney function and treat infection risk.
- The procedure is usually quick (about 30–60 minutes) and done in hospital by a specialist.
- Imaging guidance improves safety and success is often immediate when drainage works.
- Prepare by following fasting and medication instructions; ask about anaesthesia and recovery time.
- Seek urgent care for severe pain, heavy bleeding, fever or if the drainage stops.
What a nephrostomy is and how it helps the kidney
The body makes urine in the kidneys, which then travels down narrow tubes called the ureter into the bladder for storage before it leaves the body.
How urine normally flows
Each kidney produces urine continuously. It flows down the ureter to the bladder, where the body keeps it until passing.
What a nephrostomy tube does and where it sits
A nephrostomy tube is a thin plastic tube passed from the skin on the back into the kidney collecting system. It diverts urine into a bag to protect the kidney and help clear infection.
“The tube acts as a temporary bypass when natural flow is blocked.”
Common reasons someone may need this
When the ureter becomes blocked — for example by stones or by cancer pressing on the channel — urine can back up. Pressure rises in the kidney and function can fall, and trapped urine may become infected.
- Obstructing stones
- Cancer affecting the ureter
- Other causes of ureteral blockage
Generally this is a temporary measure that buys time to treat the underlying reason. Some people still pass urine normally, but most drainage will go through the tube and bag while the problem is managed.
Getting ready for nephrostomy insertion
Preparation for the procedure centres on a few key medical checks and clear communication.
What to tell the doctor
Patients must explain any medication that increases bleeding risk, for example warfarin or other blood thinners. They should also mention past reactions to drugs or contrast media, a history of kidney disease, previous bladder or kidney surgery, and any bleeding problems.
Report current signs of infection such as fever, chills or night sweats. These symptoms may change the timing or approach to the surgery.
Fasting, tests and bringing scans
Fasting may be required to reduce sedation and anaesthetic risk. Follow the hospital’s exact instructions on food and drink times.
Pre-procedure blood tests may check clotting and infection markers. Bring recent imaging — CT, ultrasound or MRI — because these scans help the radiologist plan the safest route.
Consent, questions and what happens on arrival
On arrival to the radiology department identity checks are confirmed. The radiologist or team explains benefits, risks and alternatives and answers any questions.
An intravenous cannula is usually placed so antibiotics, fluids or sedation can be given. Consent is only completed once all queries are answered and the patient feels ready to proceed.
- Checklist to tell the team: blood-thinning medication, allergies, infection signs, past surgeries.
- Bring: all relevant scans and printed reports.
- Ask: about anaesthetic options, recovery time and next steps.
For more essential pre-surgery information see essential pre-surgery information.
Nephrostomy procedure: what happens in hospital
In hospital, the team use real-time imaging to guide the tube into the kidney safely. This takes place in the radiology or interventional suite and is led by a radiologist with ultrasound and X‑ray staff assisting.
Anaesthetic and comfort
A small cannula is inserted into a vein for fluids, antibiotics and sedatives. The skin on the back is numbed with local anaesthetic so the patient feels little pain.
Positioning and sterile setup
The patient lies on their tummy on an X‑ray table. The skin is cleaned and sterile drapes create a theatre‑like field.
Step-by-step placement
- A fine needle is placed into the kidney using ultrasound and X‑ray images.
- A thin wire passes through the needle to hold the route.
- The tube is then slid over the wire and positioned in the collecting system.
Checking position and securing the tube
A small amount of contrast (X‑ray dye) outlines the collecting system so the team can confirm correct placement and assess drainage.
The tube is fixed at the skin with dressings, clips or stitches and often locked inside the kidney with a pigtail coil to stop it moving.
Connection and what to expect
The tube is attached to a drainage bag. Initially urine may be blood‑stained; continuous flow into the bag shows successful drainage.
Time and hospital stay
The whole procedure usually takes about 30–60 minutes. Many centres observe the patient for a short period and some recommend an overnight stay for monitoring.
After effects and recovery in the first days
In the first days after insertion most people notice local soreness and a change in urine colour. The skin around the entry point may feel tender and bruising can appear. This is usually mild and improves over 1–2 days.
Expected pain, bruising and blood-stained urine
Some pain at the back and near the skin site is common. Pain relief prescribed by the team normally keeps this manageable.
Urine may look pink or blood‑stained at first. The staining often lessens within 24–48 hours as the site settles.
When to seek urgent medical advice
Contact emergency services or return to the procedure site if any of these occur:
- Worsening bleeding or large fresh blood loss.
- Increasing pain that does not improve with painkillers.
- Fever, chills or feeling unwell — possible infection.
- Reduced or stopped urine drainage into the bag.
What “successful drainage” means
Successful drainage means urine flows freely into the bag, pressure inside the kidney falls and kidney function is protected. Good drainage also helps antibiotics reach and treat any infection.
“If drainage continues, kidney function is usually maintained and infection risk falls.”
Clinicians monitor vital signs, urine output and appearance, and check the skin site soon after insertion. If an overnight stay is planned these checks help spot complications early.
Risks and complications to watch for
Knowing the main risks and warning signs after tube insertion helps people act early and seek help if needed.
Bleeding and vascular injury
Minor blood in the urine is common soon after the procedure and usually settles. Severe haemorrhage is uncommon (about 1–3%) but can occur.
Rarely a blood vessel is damaged; this may need embolisation or, in very uncommon cases, further surgery (reported up to 1–3.6%). Death from bleeding is extremely rare (<0.2%).
Infection and antibiotic use
There is a small infection risk (around 1%). Antibiotics are often given via the cannula to reduce this risk, especially if urine looks infected or the patient has a fever.
Teams may send urine samples for analysis to guide treatment and prevent worsening infection or sepsis. For detailed guidance see sepsis management guidance.
Tube blockage and dislodgement
Tubes can block (about 1%) from clots, debris or kinks, and can become dislodged if pulled or poorly secured (around 1%).
Warning signs include reduced drainage, increasing pain or leaking at the skin site. Contact the clinical team promptly if any of these occur.
Other rare complications
Damage to nearby structures and severe allergic reaction to contrast are rare (contrast reactions <1/1000). Seek immediate help for signs of severe allergy or sepsis.
How to care for a nephrostomy tube and drainage bag at home
Simple daily checks and careful hygiene are the foundation of safe home care for a nephrostomy tube and bag.
Hand hygiene and keeping the skin site clean
Clean hands before and after touching the tube, connectors, bag or dressing. Use soap and water or an alcohol sanitiser.
Keep the skin around the entry site dry and clean to reduce infection risk. If dressings get wet or soiled, change them promptly.
Inspecting the tube and site
Check the tube along the back for kinks, tugging or looseness. Look for redness, swelling or discharge at the skin area.
Watch the bag for increasing blood, cloudiness or reduced drainage. Report worrying changes to the doctor or hospital team.
Dressing, bag care and positioning
- Change dressings after showering and at least twice weekly.
- Keep the drainage bag below the level of the kidneys and secure tubing to clothing to avoid pulling.
- Empty the bag when it is about half full; expect frequent emptying (sometimes every 2–3 hours).
- Replace the bag if it leaks—do not try to patch it or place it inside another bag.
Flushing, passing urine and living with the device
Only flush the tube using sterile solution and technique shown by the hospital team. Do not improvise.
Some urine may still pass naturally, but most will drain into the bag, especially when one kidney is diverted.
“Simple routines, support and clear instructions help people feel more comfortable and confident.”
Conclusion
A clear summary helps people leave hospital confident about the next steps. This short conclusion sets out what the nephrostomy achieves and the practical actions to follow.
The main aim of the procedure is to restore urine drainage, protect kidney function and help control infection while definitive treatment is arranged. The tube also gives access for imaging or contrast if clinicians need more diagnostic information.
At home, monitor drainage volume and colour, check the tube position and the skin site, and ensure the bag hangs below the kidneys. Ask the doctor about flushing, antibiotics, pain relief and planned exchanges or removal.
Follow discharge instructions, keep follow-up appointments for review or tube exchange, and seek urgent help for severe pain, fever, heavy bleeding or if drainage stops.
