Nephrostomy Tubes and Cancer Care

A nephrostomy tube is a thin, soft tube that passes through the skin of your back straight into one kidney. It drains urine out of that kidney into a bag you wear, so urine no longer has to travel down a blocked route to the bladder.

The blocked route is the ureter. A ureter is the narrow tube that carries urine from one kidney down to the bladder. You have one for each kidney. When a ureter is squeezed shut, urine backs up and the kidney swells. That swelling is called hydronephrosis. Pressure then builds inside the kidney, and it slowly stops working.

A nephrostomy takes that pressure off. It does not treat the cancer itself. It protects the kidney while cancer treatment goes ahead, or it keeps you well enough to stay at home when cure is not the aim. Draining a blocked urinary tract accounts for 85 to 90 percent of all nephrostomy placements.

The ureters run close to many organs in the pelvis. Cancers of the bladder, prostate, cervix, womb, ovary, colon and rectum can all press on them. A tumor may squeeze a ureter from outside, grow into its wall, or block it through swollen lymph nodes nearby. Scar tissue from earlier surgery or radiotherapy can narrow a ureter months or even years later.

A block is often quiet at first. It may show up only as a rising creatinine on a blood test. Creatinine is a waste product that builds up when the kidneys fall behind. Other clues are flank pain, meaning pain in the side of the back over the kidney, or a swollen kidney spotted on a scan.

Timing matters here. If a complete block is cleared within about one week, kidney function usually comes back in full. After roughly 12 weeks of complete blockage, very little function returns. That is why your team may want to act within days rather than weeks.

Call emergency services (911 in the US, 999 or 112 in the UK) or go to the emergency department if:

• Your temperature is 38.0 °C / 100.4 °F or higher. The CDC uses 100.4 °F and the NCI uses 100.5 °F. Use the lower number.
• You have shaking chills, even if the thermometer reads normal.
• You feel confused, faint, very drowsy, or your heart is racing.
• Urine in the bag turns cloudy, thick, or foul-smelling and you feel unwell with it.
• Severe flank or belly pain starts and does not settle.
• Bright red blood or clots fill the bag, or bleeding does not stop.
• The tube falls out. Cover the hole with a clean dry dressing and go in at once. Ask your team how quickly the tube must be replaced, because a track that has closed means a fresh puncture through your back.

Call your cancer team or the radiology department the same day if:

• Nothing at all has drained for several hours while you are drinking normally.
• The daily total drops sharply against your usual amount.
• Urine leaks around the tube site and soaks the dressing.
• The skin at the site turns red, hot, swollen, or oozes pus.
• The tube looks longer than before, or the stitch or anchor has come loose.

An infected kidney sitting behind a block is called pyonephrosis. It means pus is trapped with nowhere to go. It can tip into life-threatening sepsis fast. So fever with a nephrostomy is never a wait-and-see symptom.

An interventional radiologist places the tube in the X-ray department. You lie on your front. Local anaesthetic numbs the skin, and you may have light sedation as well. Ultrasound and X-ray guide a fine needle into the collecting space inside the kidney. A guide wire passes through the needle, the track is widened gently, and the drainage tube slides over the wire.

The tube is often about 8 French wide, which is under 3 millimetres. Its tip curls up inside the kidney to hold it in place. Side holes near the tip let urine and pus drain out.

The tube is then anchored at the skin with a stitch, a dressing, or a locking device. That anchor is the only thing stopping a snag from dragging the tube out. Treat it as part of the tube itself.

Urine in the bag is usually pale yellow. Pink or lightly blood-stained urine is common for the first day or two, because minor bleeding follows almost every placement. Bleeding heavy enough to need a transfusion happens in only 1 to 4 percent of people.

The site is a small wound that will not fully heal while the tube is in. A little clear or straw-colored ooze on the dressing can be normal. Steady soaking is not.

If both kidneys are drained, you will have two tubes and two bags. Label them left and right, and record each side's total on its own. If only one kidney is drained, you may still pass urine the usual way from the other one. That is expected. It does not mean the tube has failed.

• Wash your hands before and after touching the tube, bag, or dressing.
• Keep the bag below the level of your kidney at all times. Urine drains downhill. A bag lifted above the site can let urine run back.
• Empty the bag when it is about half full, so its weight does not pull on the tube.
• Change bags as often as your nurse showed you, and swap to a larger night bag before bed.
• Check the tubing for kinks, loops, and trapped weight. Do this each time you stand up or turn over in bed.
• Keep the dressing dry, and change it on the schedule you were given.
• Drink plenty unless you have been told to limit fluids. A Canadian health-technology review of nephrostomy tube management, hosted on the NCBI Bookshelf, says patients are encouraged to drink 1.5 to 2.5 litres of fluid daily, unless contraindicated, to keep the tube patent and prevent infection.
• Write down the daily total. Your own baseline is the only way to spot a real drop.

Do not flush, clamp, pull, or move the tube unless a clinician has trained you and written the steps down. If nobody taught you, the answer is no.

Nephrostomy tubes are swapped for new ones on a set schedule. Left too long, they crust up with calcium phosphate and block. StatPearls says routine changes occur every 2 to 3 months for most patients, and every 4 to 6 weeks in pregnancy. Put the next date in your phone and on paper. Ask who books it, because a missed change is a common reason people end up in the emergency department.

Ask for teaching when the tube goes in, and again at the first change. StatPearls reports that patients educated before placement and again at the first catheter exchange are half as likely to seek unnecessary urgent care.

• StatPearls (NCBI Bookshelf) — Percutaneous Nephrostomy
• MedlinePlus — Percutaneous kidney procedures
• NCBI Bookshelf — Nephrostomy and Biliary Tube Management: A Review of the Clinical Evidence and Guidelines
• CDC — Watch Out for Fever (Preventing Infections in Cancer Patients)
• National Cancer Institute — Infection and Neutropenia During Cancer Treatment