Nephrostomy & Urinary Drainage
When urine cannot drain out of the kidney, pressure builds inside it and kidney function starts to fail — and if that obstructed urine becomes infected, it is a surgical emergency. A percutaneous nephrostomy places a fine tube directly into the kidney through the skin under ultrasound and X-ray guidance, decompressing it immediately. A ureteric stent can then be placed to restore the normal internal drainage route.
Dr. Mohamed El Ghobashy · Consultant Interventional Radiologist
What it treats
- •Obstruction from stones impacted in the ureter
- •Ureteric obstruction caused by pelvic, prostate or cervical tumours
- •Infected obstructed kidney (pyonephrosis) needing urgent decompression
- •Rising creatinine from bilateral obstruction or obstruction of a single kidney
- •Renal or perinephric abscess needing drainage
Who is a candidate?
- Patients with hydronephrosis on ultrasound or CT
- Patients with obstruction plus fever or sepsis — usually an emergency
- Patients whose kidney function is deteriorating because of obstruction
- Patients in whom a retrograde stent from below has failed or is not possible
How the procedure works
- 1
Imaging
Ultrasound or CT confirms the dilated collecting system and shows the safest track into the kidney.
- 2
Puncture
With the patient lying face down or on their side under local anaesthetic and sedation, a needle is guided into the collecting system using ultrasound.
- 3
Drainage
A soft pigtail catheter is placed over a wire into the kidney and connected to a bag. Pressure falls immediately and infected urine is sent for culture.
- 4
Stenting
Once infection has settled, a JJ stent can be passed down the ureter from above so urine drains internally again and the external tube can be removed.
Recovery
Relief of pain and of the pressure on the kidney is usually immediate, and creatinine typically starts to fall within a day or two. Blood-stained urine for the first day is expected. If a nephrostomy tube stays in, you will be taught how to manage the bag; tubes are changed at planned intervals to prevent blockage. The underlying cause — a stone, a tumour — is then treated by the urology or oncology team.
Discuss this procedure
Private consultations and procedures are at Andalusia Hospitals, Maadi. Kasr Al-Ainy is Dr. El Ghobashy's academic post at Cairo University and does not take private cases.
Frequently asked questions
Is a nephrostomy permanent?
Usually not. It is most often a temporary measure to save the kidney and treat infection while the underlying cause is addressed, after which an internal stent replaces it. It is kept long term only when there is no way to re-establish internal drainage.
Is the procedure painful?
It is done under local anaesthetic with sedation. There is pressure and brief discomfort during the puncture, but most patients describe far more relief than pain, because the obstructed kidney was the source of the pain.
Can both kidneys be drained?
Yes. Where both sides are obstructed, both can be drained — sometimes in the same sitting, sometimes staged, depending on how unwell the patient is.
Other procedures
This page is general information, not medical advice for an individual. Whether a procedure suits you depends on your imaging, your history and an in-person assessment.