Fletcher Allen, a Vermont university hospital and medical center, serves all of
Vermont and the northern New York region. Located in Burlington, Fletcher Allen is a regional, academic healthcare center and teaching hospital in alliance with the University of Vermont.
Kidney Stents & Tube Placement
The urinary system serves to remove waste and regulate the amount of water in your body. The kidneys do this by forming urine. Urine from a normal kidney drains through a narrow tube, the ureter, into the bladder and out the urethra. When the ureter becomes blocked, for example by a stone, a blood clot, or a mass, the urine is unable to drain. To prevent complications a new way for urine to drain must be established. Sometimes this can be done with a percutaneous nephrostomy tube. A small tube is inserted through the skin (percutaneous) and into the kidney. With one end of the tube in the kidney, the other end can then be attached to a collection bag outside the body and the urine can drain into it.
Nephrostomy tubes may also be inserted just prior to kidney stone removal surgery, in the Interventional Radiology Department to facilitate the surgeon's access to the kidney stone.
Sometimes a percutaneous stent is placed, which is a small tube that is inserted through the skin, into the kidney and through the ureter into the bladder. The tube has side holes in it to drain the urine from the kidney. The urine will flow down the tube and into the bladder. With one end of the tube in the bladder, the other end can then be attached to a collection bag outside the body and the urine can drain into it as well if needed. When an internal stent is placed, a tube is placed from the kidney to the bladder. Generally this is done after you have had a percutaneous nephroureteral stent and you continue to require a stent be in place. In this case, the tube is completely internal and the urine drains from the kidney, through the tube and into the bladder. In any case, depending on the reason for the stent, these will need to be changed every 12 weeks for as long as you have the tube.
What happens during the procedure?
Conscious sedation is usually provided prior to starting the procedure. Monitoring equipment (blood pressure cuff, EKG, Oxygen saturation) will be in place. You will lie face down on the x-ray table. The skin overlying the flank is cleaned with a betadine solution after which sterile drapes are placed around the planned drainage site. Ultrasound and/or fluoroscopy are used to select the best site from which to approach the area to be drained and lidocaine local anesthesia is injected into the overlying skin. A needle is used to puncture the collecting system and a small amount of dye called "contrast" is injected so that the Interventional Radiologist can better visualize the kidney. A guide wire will be placed through the needle into the kidney and the needle is removed. You may feel some pressure while the tube is being placed. If it is uncomfortable the nurse can give you pain medication through your IV.
Once the tube is in the proper position, the wire is removed and a small amount of contrast injected to confirm with an x-ray that the tube is in the right place. The tube is then secured internally by forming a loop in the kidney with the tube, and with a small plastic disc that is sutured to the skin. This procedure takes approximately one hour.
What happens after the procedure?
Immediately after the procedure you will go to the recovery area for a few hours. This allows time for the conscious sedation to wear off and for monitoring to occur. The initial drainage from the tube may be blood tinged, this is a normal occurrence. It should not be blood alone and should change in color to that of normal urine within 48-72 hours.
The drainage catheter is connected to a bag which will be secured to the leg. The tube needs to be flushed with saline at least three times each day for the first 24-48 hours so that it does not become blocked by debris. Patients may require an antibiotic if infection is coexistent.
Patients are monitored for signs of improvement and the daily drainage from the tube is recorded. When the blockage is resolved, the tube is removed.
Will I continue to urinate even though I have a nephrostomy tube?
If your other kidney functions normally, it will continue to produce urine and fill your bladder. Therefore you will still urinate. If you have nephrostomy tubes in both kidneys, you may still urinate if the obstruction of the ureter(s) is relieved.
In both of these instances, you may have urine draining into the bag and into your bladder.
If you have any questions or need to reschedule an appointment please feel free to contact the Interventional Radiology Office at 802-847-8359. Our business hours are Monday - Friday, 8:30 a.m. to 5 p.m. Someone is available to take your call after hours for emergencies.
This information is provided by the Fletcher Allen Health Care, Department of Radiology, Division of Interventional Radiology and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact your health care provider.