Nephrostomy Tube: Why It's Placed, How to Live With It, and When It's an Emergency

A nephrostomy tube (percutaneous nephrostomy) is a small, flexible catheter inserted through the skin of your back directly into the collecting system of the kidney, usually under local anesthetic with sedation and image guidance. The end coils inside the kidney to hold it in place, and the other end connects to a drainage bag worn outside the body.

The common reason it is needed is a blockage that stops urine leaving the kidney. That can be a kidney or ureteral stone, a narrowing or scar, blood clots, a ureter compressed or invaded by a tumor, or advanced pelvic cancer (bladder, cervical, prostate, colorectal). The backed-up urine causes hydronephrosis, swelling of the kidney, which can damage it and breed infection if not relieved.

It is also used to protect the kidney before or after surgery, to divert urine away from a leak or injury to the ureter, and as access for some stone procedures. Whether it is temporary (until a stone passes or surgery fixes the blockage) or longer term (when a tumor cannot be removed) depends entirely on the underlying cause, which is the conversation to have with your urologist.

Two devices can relieve the same blockage, and which one you get is the question patients most want answered. A ureteral stent is a soft tube that sits entirely inside you, running from the kidney down to the bladder, with nothing showing on the outside. A nephrostomy tube exits through your back into an external bag. Both keep urine flowing; they just route it differently.

A urologist or interventional radiologist may favor a nephrostomy tube when the kidney is severely infected and needs the most reliable drainage, when a stent cannot be passed up from below, when the ureter is completely blocked by tumor, or when they need to measure exactly how much urine the kidney makes. A stent is often preferred when the patient wants nothing external, when long-term comfort matters, or when the blockage can be crossed from the bladder side under anesthesia.

These are not permanent choices locked in forever. It is common to start with one and switch later: an emergency nephrostomy can be converted to an internal stent once the infection clears, or a failed stent can be backed up by a nephrostomy. Ask your urologist which fits your specific blockage, how long you are likely to need drainage, and whether switching to a stent later is realistic for you. Our companion guide on ureteral stents covers the internal-stent experience in detail.

Most people can live a normal life with a nephrostomy tube once they learn the routine: working, traveling, and most daily activities are usually fine. The bag can be hidden under clothing, and many patients use a smaller leg bag during the day and a larger bag at night.

Yes, you usually still urinate. If only one kidney is being drained and the other works normally, that kidney still sends urine to the bladder, so you pee as usual while the tube collects from the blocked side. If both kidneys are diverted, the bag may collect most or all of your urine. The mix depends on your anatomy, so ask your team what to expect for you.

For sleeping, hang or lay the drainage bag below the level of your kidney so urine flows downhill and does not back up, and secure the tubing so you do not roll onto or tug it. Many people sleep on the opposite side or on their back, and a night bag on a stand or hooked to the bed frame avoids kinks. Showering is generally allowed once the site has healed using a waterproof dressing; baths, swimming, and submerging the site are usually discouraged. Avoid heavy lifting and vigorous activity that could pull the tube out, and keep the tube taped securely to your skin so it cannot snag.

There is no hard limit on how long a nephrostomy tube can stay in, but the tube itself is not left in indefinitely without service. Tubes are routinely exchanged for a fresh one, commonly about every 2 to 3 months, to prevent blockage, encrustation, and infection. The exchange is a quick outpatient procedure over a guidewire, far simpler than the first placement. How long you need a tube at all depends on whether the underlying blockage can be fixed.

Removal is usually straightforward: once the blockage is resolved and your urologist confirms the kidney is draining normally, the tube is simply withdrawn in the office or IR suite, and the small tract typically closes on its own within a day or two. Some patients have a tube for weeks (while a stone is treated); others, such as those with inoperable tumors, may keep one long term with regular exchanges.

At home, keep the dressing clean and dry, watch that the tube is not kinked or pulled, keep the bag below kidney level, and follow your team's instructions on flushing only if and how they direct (never flush on your own unless trained). Call your urology or IR team promptly for: fever above 101F or chills, cloudy or foul urine or pus, urine that turns deep red like beet juice rather than the lighter grapefruit-juice pink of minor bleeding, the tube leaking around the skin or stopping draining, the tube coming part or all the way out, or worsening back pain. Those are the home thresholds that separate routine from urgent.

A nephrostomy tube is usually placed as an outpatient procedure by interventional radiology, so the costs are the procedure itself, image guidance, the periodic tube exchanges every couple of months, and the drainage-bag supplies. When it is placed emergently for an infected kidney, it is bundled into the hospital admission, which is the larger expense. Because pricing varies widely by facility and insurance, ask for an itemized estimate and confirm coverage before any planned (non-emergency) placement or exchange.

Two specialties share the work, and knowing who does what saves confusion. An interventional radiologist typically places, exchanges, and removes the tube itself. A urologist manages the underlying problem, the stone, narrowing, or tumor causing the blockage, and decides the longer-term plan, including whether you can move to an internal stent or have the obstruction fixed for good.

The practical questions to ask: Is this temporary or long term? Could an internal stent work for me instead? How often will exchanges be needed and where? What will placement, each exchange, and supplies cost under my plan? Bringing those to your appointment turns an anxious unknown into a clear plan. If you do not yet have a urologist coordinating the bigger picture, that is the person to find next.