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Nephrostomy Tube for Kidney Stone: Patient Guide

Nephrostomy Tube for Kidney Stone: Patient Guide

📖 9 min read Written/reviewed by Dr. Alhad Naragude, MBBS, MS, DrNB Urology Last updated: June 23, 2026

A nephrostomy tube for kidney stone is a small drainage tube placed through the skin of your back into the kidney. It is usually needed when a stone blocks urine flow and the kidney must be drained urgently, especially if there is fever, infection, severe pain, hydronephrosis, rising creatinine or a single functioning kidney. The tube usually does not remove the stone. Its main purpose is to drain urine, reduce pressure, control infection risk and make you safer for the next treatment such as URSL, RIRS or PCNL.

What is a nephrostomy tube?

A nephrostomy tube is a soft tube placed directly into the kidney from the back. It is also called a PCN tube or percutaneous nephrostomy.

Normally, urine flows from the kidney to the bladder through a narrow tube called the ureter. If a stone blocks the ureter, urine may get trapped inside the kidney. This can cause pain, swelling, infection and kidney function problems.

A nephrostomy tube bypasses that blockage. Urine drains from the kidney through the tube into an external urine bag.

This does not mean the kidney has been removed. It also does not mean you will need a permanent bag in most stone cases. For kidney stone patients, a nephrostomy is usually a temporary safety step.

Why is a nephrostomy tube placed for kidney stones?

A nephrostomy tube is placed when the kidney needs urgent or reliable drainage.

Common reasons include:

  • Kidney stone with fever or urine infection.
  • Stone causing hydronephrosis, meaning swelling of the kidney due to blocked urine.
  • Severe pain not improving with medicines.
  • Rising creatinine or worsening kidney function.
  • Stone blockage in a single functioning kidney.
  • Blockage of both kidneys.
  • Pus in the kidney, called pyonephrosis.
  • Severe infection or sepsis due to an obstructed kidney.
  • Large stone where planned PCNL surgery may be needed.
  • Patient condition where immediate stone removal is unsafe.

The European Association of Urology states that an obstructed kidney with urinary infection signs or no urine output is a urological emergency. It recommends urgent decompression using either ureteral stenting or percutaneous nephrostomy when sepsis is present with obstructing stones.

The main idea: drainage first, stone treatment later

Many patients feel confused when a nephrostomy tube is placed but the stone is still inside. That is normal.

In emergency stone blockage, the first goal is not always stone removal. The first goal is to make the kidney safe.

The usual sequence is: blocked kidney -> urgent drainage -> antibiotics and stabilisation -> urine culture control -> definitive stone treatment.

Definitive stone removal is often delayed until infection or sepsis has settled. This approach reduces the risk of worsening infection during stone surgery.

Does a nephrostomy tube remove the kidney stone?

Usually, no.

A nephrostomy tube drains urine. It does not usually break or remove the stone.

It helps by:

  • Relieving pressure inside the kidney.
  • Draining infected urine or pus.
  • Helping fever and sepsis control.
  • Protecting kidney function.
  • Allowing time for safer stone surgery planning.

After the emergency settles, the urologist decides whether you need URSL, RIRS, PCNL, mini-PCNL, DJ stenting or observation.

Nephrostomy tube vs DJ stent: what is the difference?

Both nephrostomy and DJ stenting can drain a blocked kidney. The difference is the route.

Point Nephrostomy tube DJ stent
Route Through skin of back into kidney Through bladder into ureter
Urine drains into External urine bag Bladder
Tube visibility Outside the body Inside the body
Often useful when Severe infection, pus, difficult ureter access, very sick patient Stable patient, ureter can be accessed safely
Common discomfort Back tube site, bag handling, dressing care Burning, frequency, urgency, flank pain while passing urine
Removal Removed from back when safe Removed by cystoscopy or stent string, depending on case

EAU guidelines note that ureteral stents and percutaneous nephrostomy catheters are both effective for decompression of the renal collecting system.

Which is better: nephrostomy or DJ stent?

Neither is better for every patient. The safest drainage option depends on the emergency situation.

A urologist chooses based on:

  • Severity of infection.
  • Patient’s blood pressure and general condition.
  • Stone size and location.
  • Degree of hydronephrosis.
  • Whether the ureter can be safely accessed.
  • Availability of emergency OT, anaesthesia and imaging support.
  • Pregnancy, blood thinners, kidney function and other medical issues.

In a very sick patient with an infected blocked kidney, the fastest and safest drainage option is usually preferred.

How is a nephrostomy tube inserted?

A nephrostomy tube is usually placed by a urologist or interventional radiologist using ultrasound and/or X-ray guidance.

The usual steps are:

  1. You lie on your stomach or slightly turned to one side.
  2. The back is cleaned with antiseptic solution.
  3. Local anaesthesia is given to numb the skin and deeper tissues.
  4. A small needle is guided into the kidney.
  5. A guidewire is passed.
  6. A soft drainage tube is placed into the kidney.
  7. The tube is fixed to the skin.
  8. The tube is connected to a urine bag.

Some patients may receive sedation. Very sick patients may need monitoring, IV fluids, antibiotics and sometimes ICU care.

Is nephrostomy tube placement painful?

You may feel pressure, pulling or discomfort during the procedure. Local anaesthesia helps reduce pain.

After the tube is placed, mild back soreness is common. This usually improves. Severe worsening pain, fever, heavy bleeding or no urine drainage should be checked urgently.

What is normal after nephrostomy placement?

Some symptoms can be expected:

  • Mild pain at the tube site.
  • Light blood staining in the urine bag.
  • Urine draining into the external bag.
  • Mild pulling sensation during movement.
  • Dressing around the tube site.
  • Need to sleep carefully to avoid tube pulling.

Light blood-stained urine can occur after nephrostomy, but heavy or persistent bleeding needs urgent medical review. NHS patient guidance also advises keeping the nephrostomy tube secured, unkinked and draining properly.

How to care for a nephrostomy tube at home

Your hospital team should teach you tube and bag care before discharge. Follow their specific instructions because tube type and local protocols can vary.

General care advice:

  • Keep the urine bag below kidney level.
  • Do not allow the tube to kink, twist or pull.
  • Empty the bag before it becomes too full.
  • Keep the tube fixed securely.
  • Keep the dressing clean and dry.
  • Wash hands before and after touching the tube or bag.
  • Do not pull, cut or remove the tube.
  • Do not flush the tube unless trained by your doctor or nurse.
  • Do not apply powders, oils or creams near the tube site unless advised.
  • Take antibiotics and other medicines exactly as prescribed.
  • Attend follow-up on the advised date.

Bathing, sleeping and movement

Most patients can walk carefully with a nephrostomy tube.

Practical tips:

  • Prefer sponge bath until your doctor allows bathing.
  • Avoid soaking the tube site in a bathtub.
  • Avoid swimming.
  • Keep the dressing dry.
  • Wear loose clothing.
  • Sleep on the opposite side if comfortable.
  • Keep the urine bag supported while sleeping.
  • Avoid sudden twisting, bending or pulling.
  • Avoid heavy lifting, gym workouts, cycling and contact sports until cleared.

Return to work depends on your pain, infection status, work type and next planned stone procedure. Desk work may be possible earlier than physical labour.

What if urine is still coming normally?

This can happen.

If only one kidney has a nephrostomy tube, the other kidney may still drain urine normally into the bladder. So you may pass urine normally and also see urine in the nephrostomy bag.

If the stone blockage is partial, some urine from the affected kidney may also pass into the bladder.

What if urine stops coming into the bag?

This needs attention.

Possible causes include:

  • Kinked tube.
  • Full or wrongly positioned bag.
  • Tube blockage.
  • Blood clot or debris.
  • Tube displacement.
  • Dehydration.
  • Kidney not producing enough urine due to illness.

First, check that the tube is not kinked and the bag is below kidney level. If drainage does not restart, or if you develop pain or fever, contact your treating hospital urgently.

Can urine leak around the nephrostomy tube?

Small occasional dampness may happen, but persistent leakage is not normal.

Leakage around the tube can mean:

  • Tube blockage.
  • Tube displacement.
  • Kinked drainage tube.
  • Bag not draining properly.
  • High pressure inside the kidney.

If urine is leaking around the tube and the bag is not filling properly, get medical help.

Red flags: when to seek urgent medical care

Go to emergency care or contact your urologist urgently if you notice:

  • Fever, chills or shivering.
  • Tube stops draining urine.
  • Severe flank pain after the tube was draining earlier.
  • Tube comes out partially or fully.
  • Heavy bleeding in the urine bag.
  • Thick pus, foul smell or very cloudy urine.
  • Redness, swelling or discharge around the tube site.
  • Urine leaking around the tube with poor bag drainage.
  • Dizziness, confusion or low blood pressure symptoms.
  • Vomiting and inability to drink fluids.
  • Reduced urine output from both normal passage and nephrostomy bag.

Do not try to push the tube back in if it comes out. Cover the area with clean gauze and seek urgent care.

What happens to the stone after nephrostomy?

Once fever, infection, kidney function and pain are controlled, the urologist plans definitive stone treatment.

The main options are:

URSL

URSL, or ureteroscopy for ureteric stone, is commonly used for stones stuck in the ureter. A small scope is passed through the urinary passage. The stone may be removed or broken with laser.

RIRS

RIRS, or retrograde intrarenal surgery, is used for selected kidney stones. A flexible scope is passed through the urinary passage into the kidney. The stone is dusted with laser.

PCNL or mini-PCNL

PCNL, or percutaneous nephrolithotomy, is used for large or complex kidney stones. A small tract is made through the back into the kidney to remove the stone. NIDDK describes PCNL as a hospital procedure where a nephroscope is inserted directly into the kidney through a small back incision to locate and remove stones.

DJ stent placement

Sometimes a DJ stent is placed later to allow internal drainage while the ureter heals.

Observation in selected cases

In carefully selected patients with small stones, observation or medical expulsive therapy may be considered after the emergency has settled. This depends on stone size, location, infection status, symptoms and kidney function.

How long does a nephrostomy tube stay?

There is no fixed duration.

For kidney stone patients, a nephrostomy tube may stay until:

  • Infection settles.
  • Fever resolves.
  • Urine culture is controlled.
  • Creatinine improves.
  • Kidney drainage is safe.
  • Definitive stone surgery is completed.
  • A DJ stent or another drainage route is placed.

Some patients need it for a few days. Others may need it for a few weeks. If it must stay longer, tube change may be needed according to hospital protocol.

Do not miss follow-up. A blocked or forgotten nephrostomy tube can cause infection, leakage, pain or kidney function problems.

Does a nephrostomy tube mean kidney failure?

Not necessarily.

A nephrostomy tube means the kidney needs drainage. In many stone patients, kidney function improves after the obstruction is relieved, especially when treated in time.

However, if blockage, infection or kidney function abnormality is severe, follow-up blood tests and imaging are important.

Can a nephrostomy tube be removed at home?

No.

Do not remove the tube yourself. It should be removed by a trained healthcare professional when your urologist confirms that drainage is no longer needed.

Removal timing depends on:

  • Stone treatment status.
  • Infection control.
  • Kidney swelling.
  • Urine drainage route.
  • Follow-up imaging.
  • Kidney function.

What to bring for consultation

Bring:

  • USG KUB report.
  • CT KUB images and report, if done.
  • Urine routine report.
  • Urine culture and sensitivity report.
  • Serum creatinine and kidney function tests.
  • CBC and infection markers, if available.
  • Hospital discharge summary.
  • Nephrostomy insertion note.
  • Date and side of nephrostomy placement.
  • Current antibiotics and pain medicines.
  • Diabetes, BP and blood thinner medicine list.
  • Allergy history.
  • Previous stone surgery records, if any.

Questions to ask your urologist

  • Why was a nephrostomy tube needed in my case?
  • Is my infection controlled now?
  • Is my kidney draining well?
  • Where exactly is the stone?
  • Do I need URSL, RIRS, PCNL or mini-PCNL?
  • When can the nephrostomy tube be removed?
  • Will I need a DJ stent?
  • What should I do if the tube stops draining?
  • How can I prevent future stones?

FAQs

Is a nephrostomy tube for kidney stone serious?

It is usually placed because the kidney stone blockage needs urgent drainage. The tube is a safety measure. The more serious issue is often the blocked or infected kidney behind the stone.

Does nephrostomy mean my kidney is permanently damaged?

Not always. Many patients improve after drainage and stone treatment. Kidney recovery depends on how long the blockage was present, infection severity and baseline kidney health.

Does a nephrostomy tube remove the stone?

Usually, no. It drains urine from the kidney. Stone removal is planned separately using URSL, RIRS, PCNL, mini-PCNL or another option.

Is DJ stent better than nephrostomy?

Not for every patient. Both can drain the kidney. The choice depends on infection, stone position, patient stability, anatomy and whether the ureter can be safely accessed.

Can I walk with a nephrostomy tube?

Yes, most patients can walk carefully. Keep the tube secured and avoid pulling, bending or twisting it.

What if urine stops coming into the nephrostomy bag?

Check for kinks and make sure the bag is below kidney level. If drainage does not restart, or if you have pain or fever, seek urgent medical care.

Can urine leak around the tube?

Persistent leakage may mean blockage or tube displacement. It should be checked, especially if the bag is not filling.

Can the nephrostomy tube come out?

Yes, it can get displaced if pulled. Do not push it back in. Cover the site with clean gauze and contact your hospital or urologist urgently.

When will the nephrostomy tube be removed?

It is removed when the kidney has safe drainage and the stone plan is completed or stabilised. The exact timing depends on infection, kidney function, imaging and planned surgery.

Can I sleep normally with a nephrostomy tube?

You can sleep, but you may need position adjustments. Many patients are more comfortable sleeping on the opposite side. Keep the tube and bag supported to avoid pulling.

Related reading

References

Note: This information is for educational purposes only and is not a substitute for medical advice. Please consult your doctor for any symptoms.