Percutaneous urinary procedures - discharge
Percutaneous nephrostomy - discharge; Percutaneous nephrostolithotomy - discharge; PCNL - discharge; Nephrolithotomy - discharge; Percutaneous lithotripsy - discharge; Endoscopic lithotripsy - discharge; Kidney stent - discharge; Ureteric stent - discharge; Renal calculi - nephrostomy; Nephrolithiasis - nephrostomy; Stones and kidney - self-care; Calcium stones - nephrostomy; Oxalate stones - nephrostomy; Uric acid stones - nephrostomy
You had a procedure to drain urine from your kidney or to get rid of kidney stones. This article gives you advice on what to expect after the procedure and steps you should take to care for yourself.
The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and the stimulation of red blood cell production.
If you ever have severe pain in your belly or one side of your back that comes and goes suddenly, you may be passing a kidney stone. Let's talk about the painful condition of kidney stones. A kidney stone is a mass of tiny crystals in your kidney or urinary tract. Stones are quite common, and tend to run in families. They can form in weeks or months when your urine contains too much of certain substances. There are several kinds of kidney stones. Calcium stones are by far the most common kind. They often form in men between the ages of 20 to 30. Calcium can combine with other substances found in your food, like oxalate, phosphate, or carbonate, to form stones. Cystine stones can form in people who have cystinuria, a condition passed down through families in which stones are made from an amino acid called cystine. Struvite stones are found mostly in women who have urinary tract infections. These stones can grow very large and can block the kidney, ureter, or bladder. Uric acid stones are more common in men than in women. They can occur in people who have a history of gout or are going through chemotherapy. So, how do you know if you have kidney stones? Well, you may not have symptoms until the stone move down the ureter tubes through which urine empties into your bladder. When this happens, the stones can block the flow of urine out of your kidneys. The main symptom is severe sharp pain that starts suddenly, usually in your belly or one side of your back, and it may go away just as quickly. Other symptoms can include abnormal urine color, blood in your urine, fever, chills, nausea, and vomiting. So, what do you do about kidney stones? Well, your health care provider will perform a physical exam. You may need blood tests, kidney function tests, and tests that look for crystals in your urine. Several imaging tests, like a CT scan, can see stones or a blockage in your urinary tract. Treatment will depend on the type of stone you have, and how bad your symptoms are. Small kidney stones that are less than 5 mm in diameter will usually pass on their own. You should drink at least 6 to 8 glasses of water per day to produce a large enough amount of urine to help bring the stone out. Pain can be pretty bad when you pass a kidney stone, so your doctor may prescribe pain medicines to help as well as medications that will help the stone pass. Other medicines can decrease stone formation or help break down and remove the material that is causing you to make stones. You may need surgery if the stone is too large to pass, the stone is growing, or the stone is blocking your urine flow. Kidney stones are painful, but you can usually pass them without causing permanent harm. However, kidney stones often come back, so you and your doctor will need to work on finding the cause of your stone. Lastly, delaying treatment can lead to serious complications, so if you think that you have kidney stones see your doctor right away.
Kidney stones result when urine becomes too concentrated and substances in the urine crystalize to form stones. Symptoms arise when the stones begin to move down the ureter causing intense pain. Kidney stones may form in the pelvis or calyces of the kidney or in the ureter.
When You're in the Hospital
You had percutaneous (through the skin) urinary procedures to help drain urine from your kidney and get rid of kidney stones.
If you had a percutaneous nephrostomy, the health care provider inserted a small, flexible catheter (tube) through your skin into your kidney to drain your urine.
If you also had percutaneous nephrostolithotomy (or nephrolithotomy), the provider passed a small medical instrument through your skin into your kidney. This was done to break up or remove kidney stones.
What to Expect at Home
You may have some pain in your back for the first week after the catheter was inserted into the kidney. Over-the-counter pain medicine such as Tylenol may help with the pain. Other pain medicines, such as aspirin or ibuprofen (Advil) can also help, but your provider may recommend you not to take these medicines because they can increase your risk for bleeding.
You may have some clear-to-light yellow drainage around the catheter insertion site for the first 1 to 3 days. This is normal.
A tube that comes from your kidney will pass through the skin on your back. This helps the urine flow from your kidney into a bag that is attached to your leg. You may see some blood in the bag at first. This is normal and should clear over time.
Caring for Your Tubes and Catheters
Proper care of your nephrostomy catheter is important so you do not get an infection.
- During the day, you may use a small urinary bag that is attached to your leg.
- Use a larger drainage bag at night if recommended by your doctor.
- Always keep the urinary bag below the level of your kidneys.
- Empty the bag before it is completely full.
- Wash your drainage bag once a week using a solution of half white vinegar and half water. Rinse it well with water and allow it to air dry.
Drink plenty of liquids (2 to 3 liters) every day, unless your provider tells you not to do so.
Avoid any activity that causes a pulling sensation, pain around the catheter, or kinking in the catheter. Do not swim when you have this catheter.
Your provider will recommend that you take sponge baths so that your dressing stays dry. You may take a shower if you wrap the dressing with plastic wrap and replace the dressing if it gets damp. Do not soak in a bathtub or hot tub.
Dressing Changes
Your provider will show you how to place a new dressing. You may need assistance since the dressing will be on your back.
Change your dressing every 2 to 3 days for the first week. Change it more often if it gets dirty, wet, or becomes loose. After the first week, change your dressing once a week, or more often as needed.
You will need some supplies when you change your dressing. These include: Telfa (the dressing material), Tegaderm (the clear plastic tape), scissors, split gauze sponges, 4-inch x 4-inch (10 cm x 10 cm) gauze sponges, tape, connecting tube, hydrogen peroxide, and warm water (plus a clean container to mix them in), and a drainage bag (if needed).
Always wash your hands well with soap and water before you remove the old dressing. Wash them again before you put on the new dressing.
Be careful when you take off the old dressing:
- Do not pull on the drainage catheter.
- If there is a plastic ring keep it against your skin.
- Check to see that the sutures (stitches) or the device that holds your catheter against your skin is secure.
When the old dressing is off, gently clean the skin around your catheter. Use a cotton swab soaked with a solution of half hydrogen peroxide and half warm water. Pat it dry with a clean cloth.
Look at the skin around your catheter for any increase in redness, tenderness, or drainage. Call your provider if you notice these changes.
Place a clean dressing the way your provider showed you.
If possible, have family or a friend change the dressing for you. This makes the process easier.
When to Call the Doctor
Contact your provider if you have any of these symptoms:
- Pain in your back or side that will not go away or is getting worse
- Blood in your urine after the first few days
- Fever and chills
- Vomiting
- Urine that smells bad or looks cloudy
- Worsening redness or pain of the skin around the tube
Also contact if:
- The plastic ring is pulling away from your skin.
- The catheter has pulled out.
- The catheter stops draining urine into the bag.
- The catheter is kinked.
- Your skin under the tape is irritated.
- Urine is leaking around the catheter or plastic ring.
- You have redness, swelling, or pain where the catheter comes out of your skin.
- There is more drainage than usual on your dressings.
- The drainage is bloody or contains pus.
References
Bushinsky DA. Nephrolithiasis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 117.
Matlaga BR, Krambeck AE. Surgical management for upper urinary tract calculi. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 94.
Version Info
Last reviewed on: 7/4/2022
Reviewed by: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
