Interventional Radiology for Kidney Stones and Urinary Tract Reconstruction

Interventional radiology can be used to help with kidney stones and reconstruction of the urinary tract.

Dr. Pruna (Role of IR in Kidney Stone Management)

Percutaneous Nephrostomy Tube

A percutaneous nephrostomy tube is a tube placed through the back into the kidney. A drainage tube collects urine from the kidney and exits the back. This is typically connected to a bag which drains urine from the kidney. A percutaneous nephrostomy tube may be placed in preparation for a kidney stone surgery called percutaneous nephrolithotripsy (PCNL).

A percutaneous nephrostomy tube may also be placed in preparation for surgery of the kidney tube (ureter). This includes

-Ureteropelvic junction obstruction (UPJ obstruction) in preparation for reconstructive surgery called pyeloplasty
-Narrowing or stricture of the kidney tube (ureter) in preparation for reconstructive surgery
-Kidney swelling (hydronephrosis) due to tumor in preparation for further surgery or chemotherapy of the urinary tract

Nephroureteral Stent

A nephroureteral stent is a plastic tube that travels from the bladder, up through the kidney tube (ureter) through the kidney and out the back. This is typically placed to a drainage bag to collect the urine. A nephroureteral stent is typically placed in preparation for upcoming surgery along with urinary tract.

Suprapubic Tube

A suprapubic tube is a plastic tube placed in the bladder that exits out the belly wall. This is placed to a drainage bag to collect the urine. This is placed when there is a narrowing or blockage of the normal urinary pathway (urethra).

Nephrostomy Tube Care Instructions

What is a nephrostomy tube?
A nephrostomy tube is a thin, flexible tube that allows urine to drain from the kidney into a bag outside your body. Nephrostomy tubes are most commonly used for patients with a history of kidney stones, problem with the kidney tube (ureter), kidney infections, or other conditions causing an inability to purine from the kidney to the bladder.

After placement of a nephrostomy tube

• It is normal to experience some pain and discomfort around the puncture site for several days.
• When climbing up steps or bending down, some patients find it more comfortable if you place your hand on the tube. - When placing your hand on the tube, make sure to not pull the tube.
• It is OK to see some pink in your urine for 48 hours following placement of the tube. If the nephrostomy is not draining, try changing position and drinking more water. If it is still not draining, some IR centers instruct patients to flush the nephrostomy with sterile water or saline. If it still does not drain, contact the office.

Activity

• Avoid all activities that cause pain, a pulling sensation, or kink of the nephrostomy tube.
• Avoid heavy lifting or activities with bending forward.
• Keep the nephrostomy tube well secured to the body with over-the-counter medical tape in two locations at all times.

Diet

• You can continue to eat your normal diet. Make sure to drink plenty of water and avoid constipation.

Medications

• You can continue to take your normal, prescribed medications unless told otherwise by your provider.
• If you begin to experience pain, you may take an over-the-counter medication to help alleviate the pain.

Showering and bathing

• Do not shower 48 hours following placement of the nephrostomy tube.
• If you shower during the first 14 days after the tube has been placed, cover the dressing with a double layer of Saran wrap and tape the wrap to your skin to avoid any water from coming into contact with the tube and puncture site.
• After showering, remove the Saran wrap and change your dressing.
• Following the first 14 days, you may shower without a dressing or wrap on the puncture site. Make sure to rinse and dry the area well and apply a clean dressing after your shower. If you decide to sit in a bathtub, the water level should be below the site of the tube.
• Avoid hot tubs and swimming as submerging the puncture site under water increases risk of infection.

Changing the dressing

• Dressing should be changed after showering or every 1-2 days
• Once the old dressing is removed, clean around the tube with a clean washcloth, using water and a small amount of liquid soap.
• Make sure to rinse and dry well
• Apply a new dressing, making sure there is no kink in the tube. You may use over-the-counter gauze and medical tape.
• Keep the tube well secured at all times. Secure the tube and at least two places. You may use over-the-counter medical tape to secure the nephrostomy tube

How often is my tube changed?

• Nephrostomy tubes are typically changed every 12 weeks in interventional radiology.

How do I know if something is wrong with my tube?

• Call the office nausea, vomiting or fever, please reach out to your provider immediately.
• If the nephrostomy tube stops draining and you have tried drinking water, and changing position, please let the office know right away.

Suprapubic Tube Placement Postoperative Instructions

Clothing
After surgery it can be difficult to fit into your regular pants. Wear comfortable pants that have a loose waistband.

Urinary Catheter

• During surgery, you will have a catheter placed in your bladder through the belly wall. A catheter is a tube that carries urine from your bladder to the outside of your body into a bag. This urinary catheter will stay in place. You may have some leakage of urine or blood from the catheter site or at the tip of the bladder tube (urethra). You may also notice some blood or mucous-type sediment in the drainage tube or in the bag. The color of the urine may vary.
• It is very important to make sure the catheter drains well. The bag should always be lower than your bladder. It is also very important that there is no pulling or tugging on the catheter itself.
• At night, the catheter should drain into a large bag. When you want to go out, you can wear a smaller bag under your pant leg. You will receive instructions about the care of your urinary catheter before discharge from the hospital.

Diet

• Drink plenty of water
• Eat lots of vegetables and fiber to avoid constipation.

Dressing
Remove the bandage over your incisions two days after surgery. You may place an over the counter gauze or dressing daily as needed for drainage.

Medications

• Resume your normal medications unless instructed otherwise.
• A pain medication to be taken by mouth will be prescribed for you. Narcotic pain medications are addictive and constipating and therefore should be discontinued as soon as possible.
• Ibuprofen, an anti-inflammatory, helps reduce discomfort after surgery. This may be prescribed or is available at any drug store without a prescription.
• Acetaminophen (Tylenol) helps decrease discomfort after surgery. This is available at any drug store without a prescription. Some narcotic pain medicines also contain acetaminophen. Do not take more than 4000 mg acetaminophen per day to avoid liver problems.
• A stool softener should be taken by mouth twice a day to avoid constipation. Constipation can cause you to strain to have a bowel movement, which puts stress on the surgery site and can impair healing. A stool softener or laxative may be prescribed or is available at any drug store without a prescription (senna or Senokot or SennaGen, Dulcolax or bisacodyl, Milk of Magnesia or magnesium hydroxide). Decrease or hold the stool softener for diarrhea or loose stools. Take stool softeners by mouth only. You make use an over the counter suppository or enema if needed.

Activity Level

• Resume your normal activity level. You may be up and about as much as you like. You may go up and down stairs. Be sure the catheter is well secured at all times without any pulling or tugging. Be sure the drainage bag is lower than the bladder/catheter.
• You may take a shower after surgery. You may allow the water to run over the incision and the catheter. The catheter can be rinsed with water but do not put soap directly on the catheter itself to avoid irritation at the tip of the penis.
• Do not take tub baths or get in a hot tub for 1 week.

Things You May Encounter After Surgery

• Bruises around the incision site: These are common and should not alarm you. They will resolve over time.
• Bloody drainage around the Foley catheter or in the urine: Especially after increased activity or after bowel movement is common. Resting for a short period of time will improve the situation.
• Leaking urine around the catheter: Urine, mucus or blood may leak around the tube. If this happens, wear your underwear with a pad inside for protection/absorption. Most of the urine should drainage into the collection bag.
• Bladder spasms: These are common. You may feel mild to severe bladder pain, an urgent need to urinate or a burning sensation. This is from the foley catheter balloon. This may resolve with position change or time. Medication for bladder spasm is available if this persists.
• Sore throat or hoarseness: This is from the breathing tube during surgery and should resolve in a few days.

Follow-up Appointments
The first one to two catheter exchange are often performed by your surgeon. After this, the catheter can be changed by the patient, caregiver or our office.

Contact Us Immediately If You Are Experiencing Any Of The Following Symptoms

• Temperature over 101°F
• Urine stops draining into the drainage bag
• Any pain unrelieved by the pain medication
• Blood clots in urine that block the catheter
• Nausea and vomiting

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