Academic Medical Center
Comprehensive Nephrology & Transplant
Joint CommissionMagnet RecognitionUNOS Transplant Center
✓ 24/7 ER✓ ICU✓ Insurance
Percutaneous nephrostomy
A percutaneous nephrostomy (PCN) is a thin tube placed through the skin of the back directly into the kidney to drain urine when a blockage stops it reaching the bladder normally. It's usually done urgently to relieve a swollen, at-risk kidney and protect its function while the underlying cause is diagnosed and treated.
Content verification
Briefly about this treatment
Indications
An obstructed, at-risk kidney — from a kidney stone, a tumour, scar tissue or an injury to the ureter — causing pain, infection, or declining kidney function that isn't resolving with medication alone.
Risks
Bleeding, infection, and problems with the drainage tube itself. Risks are minimised by using ultrasound and X-ray guidance, careful patient selection, and experienced interventional teams.
Pre-procedure
Blood tests (including clotting and kidney function), imaging to confirm the blockage, a consultation about anaesthesia or sedation, and fasting per your centre's protocol.
Follow-up
Monitoring for a few hours after placement, a scheduled review to confirm the tube is draining well, and — for longer-term tubes — periodic exchanges (often every 2–3 months) alongside treatment of the underlying blockage.
What is Percutaneous nephrostomy? An expert explains
Normally, urine flows from each kidney down a narrow tube called the ureter, into the bladder. When that tube becomes blocked, the kidney rapidly becomes affected, especially if infection is present — this is called obstructive uropathy, and left untreated it can permanently damage the kidney. To relieve the blockage quickly, a radiologist (or sometimes a urologist) uses ultrasound and X-ray guidance to pass a fine needle through the skin of your back into the kidney’s collecting system, then threads a soft plastic catheter over a guidewire into place. The catheter connects to a drainage bag outside your body, so urine bypasses the blockage entirely. This route is usually chosen when placing a stent from the bladder side isn’t possible or hasn’t worked, which is why nephrostomy is so often the first move in an emergency — other treatments for the underlying cause follow once the kidney is stable.
Signs it may be time for Percutaneous nephrostomy
A nephrostomy is usually recommended rather than chosen electively — your care team suggests it when your symptoms and imaging point to a blocked, at-risk kidney. Watch for:
- Severe one-sided flank or back pain that won’t settle, especially with fever or chills
- A sudden drop in how much urine you’re passing
- Blood in your urine together with severe pain
- Feeling generally unwell — fever, chills, nausea or vomiting — alongside a known or suspected kidney blockage
- Worsening blood test results (rising creatinine) that your doctor links to an obstruction
These symptoms can also point to an underlying condition. Conditions linked to this treatment in the directory:
- Tuberculosis of Kidney — TB infection spreads to kidney tissue.
- Paraproteinemia-Related Kidney Disease — Monoclonal proteins damage glomeruli.
- Renal Artery Stenosis — Narrowing of renal arteries reducing blood flow.
- Tumor Obstructive Nephropathy — Tumor compression or infiltration impedes urine flow.
- Parathyroid Disorders (Renal Stones) — Calcium imbalance leads to nephrolithiasis.
Remember: These entries are not a diagnosis or a treatment recommendation. Discuss your symptoms and test results with a qualified clinician.
When to consult a specialist
If you’re noticing one-sided back pain, a drop in urine output, or you already know you have a kidney stone or blockage and feel unwell, it’s worth getting checked sooner rather than later — a simple blood and urine test can often tell your clinician whether your kidney needs this kind of urgent attention. Most people who are referred for a nephrostomy are not making the decision alone; a specialist reviews your imaging and results with you and explains the options. You don’t need to work this out by yourself — find a specialist and get a clear read on what’s going on with your kidney.
How a session works
- Before you go in. Interventional radiologists specialise in interpreting imaging and using it to guide catheters and wires for diagnosis and treatment, so a member of that team explains the procedure and asks you to sign a consent form. A small IV line is usually placed in your arm.
- Positioning. You lie generally flat, or nearly flat, on your stomach on the X-ray table, with monitors on your arm, chest and finger to track your heart rate, blood pressure and oxygen.
- Sterile set-up and anaesthesia. The team wears sterile gowns and gloves; your skin is washed with antiseptic and covered with sterile drapes, then injected with local anaesthetic to numb it.
- Needle and guidewire placement. An ultrasound machine is used to look at the kidney and guide a needle through the skin into it; a guidewire is then passed through the needle, and X-ray confirms the wire is correctly positioned before the nephrostomy tube is inserted. Contrast dye is often injected so the collecting system shows up clearly on X-ray.
- Catheter placement and securing. The catheter is held in place with a stitch and a locking system that sticks to the skin, then connected to an external drainage bag.
- Duration. Most nephrostomy placements take around 30–60 minutes, though this varies with anatomy and how urgent or difficult the access is.
Session duration
30–60 minutes
recorded for this treatment
Cost verify
$300–$10000
indicative range
Anesthesia
Local
recorded for this treatment
Remember: The exact steps, duration and preparation can vary with your indication, health and care setting. Confirm the current plan with your treating team.
Benefits
A percutaneous nephrostomy relieves a blocked kidney quickly and can be done even when someone is too unwell for surgery, which is why it’s often the first move in a kidney emergency. Benefits include:
- Rapidly relieves pressure on a blocked, swelling kidney — often within minutes of the tube being placed
- Can be performed urgently, even in patients too unwell for surgery
- Buys time to treat the underlying cause (stone, tumour, stricture) safely
- Allows infected urine to drain so antibiotics can work more effectively
- Can be placed under local anaesthetic, avoiding general anaesthesia in high-risk patients
Risks & side effects
The treatment has risks and trade-offs to discuss with your care team. The information below comes from this treatment’s data: bleeding, infection, and issues with the drainage tube itself are the main risks of a percutaneous nephrostomy. Risks are minimised by using ultrasound and X-ray guidance, careful patient selection, and experienced interventional teams.
Placing a percutaneous nephrostomy tube is usually very safe, and the benefits greatly outweigh the risks, but problems can occur. The most common, generally minor issues include:
- Blood-stained urine immediately after the procedure, which usually clears within 24–48 hours
- Discomfort or bruising around the insertion site
- Temporary blockage or kinking of the tube
- A short-lived fever as bacteria are disturbed during drainage
Who it may not suit
These are general cautions, not a personal verdict. A qualified clinician must assess your full medical picture before recommending or delaying treatment. Relative cautions include uncorrectable bleeding problems, an uncooperative patient, severe respiratory disease, and severely abnormal potassium or acid levels (urgent dialysis can sometimes correct these first). Your team weighs these against the risk of leaving a blocked, infected kidney untreated.
What happens during & after
You’ll lie on your front on an imaging table; the skin over your kidney is cleaned, numbed, and a fine needle is guided into the kidney under ultrasound and X-ray; a catheter is then passed over a guidewire and secured to your skin, and urine starts draining into a bag immediately. Afterward you’re monitored for a few hours (or admitted, depending on why the tube was placed) before going home with the drainage bag in place.
Possible complications
More serious complications are uncommon, but worth knowing about. Your care team will talk through which of these apply most to your situation — the balance of risk and benefit differs between an emergency drainage and a planned one.
- More severe bleeding that, rarely, requires a blood transfusion or, very rarely, a further procedure or operation to stop it
- Blood infection (sepsis) if bacteria enter the bloodstream
- Kidney infection requiring antibiotics, or occasionally a change of tube
- Injury to a nearby organ, such as the bowel, or a nerve
- Reaction to the contrast dye used during imaging
- Accidental displacement or blockage of the tube after you go home
Remember:
New or severe symptoms require prompt medical advice. Do not wait for a routine appointment if you feel seriously unwell.
Recovery
Right after the procedure, you’ll usually rest for a few hours while your vital signs are monitored. Many patients stay in hospital overnight or longer if the nephrostomy was placed for an infection or as an emergency, while some go home the same day.
Caring for the tube at home:
- Keep the insertion site clean and dry; follow your team’s instructions on dressing changes
- Empty, and if instructed, flush the drainage bag as shown by your nurse before discharge
- Work with your care team to keep the tube working well and free from infection
- Avoid pulling, kinking, or submerging the tube (showers are usually fine once cleared by your team; baths and swimming generally aren’t, until the tube is out)
- Know who to call if you have questions or problems with the tube
How long the tube stays in. This depends entirely on why it was placed. If it’s treating a temporary blockage, it may come out once the cause is fixed. If it’s longer-term, it typically needs to be exchanged periodically — often every 2–3 months — to reduce the risk of blockage or infection.
When to seek help urgently after discharge:
- No urine draining into the bag for several hours
- Fever, chills, or feeling generally unwell
- The tube falls out or moves significantly
- Heavy bleeding, or urine that stays bright red rather than lightening over a day or two
- Severe or worsening pain at the site
Follow-up. You’ll usually have a scheduled review to check the tube is working and to plan the next step in treating the underlying blockage — stone removal, a ureteral stent, or another procedure.
Clinics offering Percutaneous nephrostomy
Verified kidney centres linked to this treatment in the KidneyGlobal directory.
University Hospital
Urologic Oncology & Robotic Surgery
ISO 9001European Urology Boardda Vinci Robotic Center
✓ 24/7 ER✓ ICU✓ Insurance
Academic Medical Center
Minimally Invasive Urologic Surgery
Joint CommissionNCI Cancer CenterRobotic Surgery Excellence
✓ 24/7 ER✓ ICU✓ Insurance
Public Hospital
Dialysis & Chronic Kidney Disease
Joint CommissionLevel I Trauma CenterESRD Network Certified
✓ 24/7 ER✓ ICU✓ Insurance
Good questions
Most Common Questions
Is a nephrostomy the same as dialysis?
No. A nephrostomy drains urine from one or both kidneys past a blockage; it doesn't filter your blood. If your kidneys also need blood filtered, that's a separate treatment, dialysis.
Is it painful?
The skin and deeper tissues are numbed with local anaesthetic before the needle is placed, and sedation is often given too, so most people feel pressure rather than sharp pain during the procedure. Some soreness at the insertion site afterward is normal.
Is a nephrostomy permanent?
Usually not. A nephrostomy tube may be in place for several days or months, depending on why it was placed; some people need it long-term if the underlying blockage can't be fixed, but for most it's a bridge to definitive treatment (stone removal, a stent, or surgery).
Will I still need surgery afterward?
Sometimes. A nephrostomy relieves the emergency, but the cause of the blockage — a stone, stricture, or tumour — often still needs its own treatment afterward.
Which specialist places a nephrostomy tube?
Usually an interventional radiologist; sometimes a urologist, depending on the hospital's setup.
Can this be done as an outpatient?
Sometimes — planned, stable cases can occasionally be done as a day case. Emergency or infected cases usually mean a hospital admission, at least for the first day or two.
Sources
- Percutaneous NephrostomyStatPearls, National Library of Medicine (NCBI Bookshelf)
- Percutaneous NephrostomyRadiopaedia.org
- Nephrostomy TubeCleveland Clinic
- Percutaneous Kidney ProceduresMedlinePlus, U.S. National Library of Medicine
- Percutaneous Nephrostomy (patient information leaflet)British Society of Interventional Radiology
- Cost of image-guided percutaneous nephrostomy among cervical cancer patients at Muhimbili National Hospital in TanzaniaCost Effectiveness and Resource Allocation (BioMed Central)