Nephrostomy Tube and Urination Function
Yes, a patient with a left nephrostomy tube will still urinate normally through the urethra, as urine from the right kidney will continue to flow through the normal urinary pathway. 1
Understanding Nephrostomy Function
A percutaneous nephrostomy (PCN) is an interventional procedure that creates an alternative drainage pathway for urine by placing a catheter directly into the renal collecting system, typically to relieve urinary obstruction. When only one kidney has a nephrostomy tube:
- The nephrostomy tube diverts urine from the affected (left) kidney directly to an external collection bag
- The unaffected (right) kidney continues to drain normally through its ureter to the bladder
- The patient will still produce urine through the urethra, though the volume may be reduced by approximately half
Clinical Considerations
Indications for Nephrostomy
Nephrostomy tubes are placed for several reasons, including:
- Acute urinary obstruction with renal function deterioration
- Pyonephrosis (infected, obstructed kidney)
- Urinary obstruction after cystectomy with urinary diversion
- Malignant obstruction of the urinary tract 1
Urinary Output Expectations
The patient should be informed that:
- They will have urine draining into the external nephrostomy bag from the left kidney
- They will still urinate through the urethra, though possibly with reduced volume
- If the right kidney becomes obstructed or fails, urination through the urethra may cease
Monitoring Requirements
Patients with nephrostomy tubes require:
- Regular monitoring of both nephrostomy output and urethral urination
- Observation for signs of infection or obstruction
- Regular catheter changes (typically every 4-12 weeks) 1
Potential Complications
Complications related to nephrostomy tubes include:
- Catheter displacement (12.6%)
- Catheter blockage (3.3%)
- Bleeding (hematuria present in approximately 50% of patients)
- Sepsis (especially in patients with diabetes and kidney stones) 1, 2
Special Considerations
Complete Bilateral Obstruction
In cases where both ureters are obstructed and bilateral nephrostomy tubes are placed, the patient would not urinate through the urethra, as all urine would be diverted through the nephrostomy tubes 3.
Temporary vs. Permanent Placement
Nephrostomy tubes may be:
- Temporary: Used until the underlying obstruction is resolved
- Permanent: Required for long-term management in cases of malignant obstruction or irreparable ureteral injury 3, 1
Warning Signs to Monitor
Patients should be instructed to seek medical attention if they experience:
- Fever or chills (signs of infection)
- Significant decrease in urine output (either from the nephrostomy tube or via urination)
- Bright red blood in urine or around the nephrostomy site
- Dislodgement of the nephrostomy tube 4
Understanding that normal urination will continue with a unilateral nephrostomy tube can help alleviate patient anxiety about this procedure and its impact on daily functioning.