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Percutaneous Nephrostomy in Zurich –Immediate Relief for the Obstructed Kidney

The kidney produces urine around the clock. When drainage is blocked — by a kidney stone, a ureteral stricture, or a tumor pressing from outside — urine backs up in the kidney. Pressure rises, the kidney swells, and if the obstruction persists, permanent kidney damage threatens. In acute cases, life-threatening urosepsis (blood poisoning from urinary tract infection) can develop within hours.

Percutaneous nephrostomy — an image-guided drain through the skin directly into the obstructed kidney — provides relief within minutes.

What Is Percutaneous Nephrostomy?

Percutaneous nephrostomy (PCN) is a minimally invasive procedure in which, under ultrasound and fluoroscopic guidance, a thin drainage catheter is inserted directly through the skin and back muscles into the renal pelvis. The backed-up urine can immediately drain, the kidney is relieved, and — if infection is present — the vicious cycle of urosepsis is broken.

A nephrostomy can serve as a temporary measure (e.g., until a kidney stone can be surgically removed or fragmented) or as a permanent drainage pathway when the ureter is permanently blocked (e.g., by a tumor).

Common causes of urinary obstruction requiring nephrostomy:

  • Kidney stone obstructing the ureter (urolithiasis)
  • Tumors of the pelvis, bladder, cervix, or prostate compressing the ureter from outside
  • Post-surgical or post-radiation ureteral strictures
  • Blood clots in the ureter
  • Congenital outflow obstruction (ureteropelvic junction obstruction)
  • Retroperitoneal fibrosis

The Procedure — Step by Step

Before the procedure

Ultrasound and/or CT to assess the kidney and plan the access pathway. Laboratory values (blood count, coagulation, kidney values). Fasting (at least 4–6 hours). Antibiotic prophylaxis administered.

Positioning

Prone or slight lateral position on the procedure table. The back/flank area is disinfected and draped sterile.

Imaging and planning

Under ultrasound or CT guidance, the dilated renal pelvis is localized. The optimal puncture path — providing direct access to the renal pelvis while avoiding important structures like vessels and bowel — is planned with millimeter precision.

Local anesthesia

Skin, muscles, and renal capsule are numbed with local anesthetic. Light sedation (conscious sedation) can be administered upon request.

Puncture

Under combined ultrasound and fluoroscopic guidance, a thin needle is precisely inserted into the renal pelvis. Once urine flows back, correct placement is confirmed.

Seldinger technique

A thin guidewire is advanced through the needle into the renal pelvis. The needle is removed, the access is gradually dilated, and the nephrostomy catheter (typically 8–12 French, approximately 3–4 mm diameter) is placed. At the catheter tip, a small safety loop (pigtail) opens to prevent the catheter from slipping out of the kidney.

Fixation and dressing

The catheter is secured to the skin and covered with a dressing. Urine immediately flows into a collection bag.

Duration

30–60 minutes including preparation and monitoring.

Inpatient or outpatient

In acute situations (urosepsis, severe pain), hospitalization is standard and advisable. Elective procedures can theoretically be performed on an outpatient basis.

After the consultation, you will receive a detailed patient information sheet with all specific instructions.

What Can Be Additionally Treated Through the Nephrostomy?

The nephrostomy catheter is not just a drain — it is simultaneously a working channel for further interventional procedures:

  • Antegrade ureteral stent implantation: Through the nephrostomy access, a double-J stent (JJ stent) is placed into the ureter, restoring urine drainage through the natural pathway. The nephrostomy catheter can then be removed.
  • Ureteral dilation: Strictures of the ureter can be dilated with a balloon through the access.
  • Percutaneous nephrolithotomy (PCNL): For large kidney stones that cannot be treated with shock waves, the nephrostomy access enables endoscopic stone removal — often in cooperation with urology.

Who Is It Suitable For — and Who Is It Not?

Suitable
  • Acute urinary obstruction with pain or fever (urosepsis — emergency indication)
  • Chronic urinary obstruction from tumor, scar, or other obstruction
  • Preparation for further procedures (JJ stent, stone treatment, radiation)
  • Acute kidney failure from bilateral urinary obstruction
Not or only partially suitable
  • Severe, uncorrectable coagulation disorders
  • No safe access pathway

FAQ — Percutaneous Nephrostomy

The procedure is performed under local anesthesia. The local anesthetic injection briefly causes a burning sensation; after that, the procedure is largely pain-free. A pressure sensation when advancing the catheter is possible. Light sedation (conscious sedation) can be administered upon request.

That depends on the cause of the obstruction. For a kidney stone: as long as it takes to treat the stone (often 3–4 weeks). For tumor-related obstruction: the catheter can remain permanently or be replaced by an internal stent. We plan the further course together with your treating urologist or oncologist.

Yes. Many patients live for weeks to months at home with a nephrostomy. The urine bag is regularly emptied, the catheter is flushed weekly to monthly, and exchanged as needed. We thoroughly train you and your family in handling it.

When bacteria multiply in obstructed urine and enter the bloodstream, urosepsis develops — a life-threatening blood poisoning. Fever, severe flank pain, and urinary obstruction are the classic warning signs. Percutaneous nephrostomy can be life-saving in this situation by immediately draining the infected stasis within hours.

Often yes. Through the nephrostomy access, an internal double-J stent (JJ stent) can be placed that keeps the ureter open from within and drains urine through the natural pathway. The nephrostomy catheter can then be removed — which is significantly more comfortable in daily life. Whether a JJ stent is possible depends on the cause and extent of the obstruction.

Slight blood in the urine for 1–2 days after the procedure is normal.

Please contact us or the emergency department immediately if you experience:

⚠ Fever above 38.0°C (100.4°F) or chills

⚠ Heavy bleeding in the urine (dark red, blood clots)

⚠ No urine flow into the collection bag

⚠ Redness or pus at the catheter insertion site

⚠ Severe flank pain that worsens

Scientific References
  • Dyer RB et al. Percutaneous nephrostomy with extensions of the technique: step by step. Radiographics. 2002;22(3):503–525.
  • Ramchandani P et al. Quality improvement guidelines for percutaneous nephrostomy. J Vasc Interv Radiol. 2016;27(3):410–414.
  • Lee WJ et al. Emergency percutaneous nephrostomy: results and complications. J Vasc Interv Radiol. 1994.
  • Hausegger KA, Portugaller HR. Percutaneous nephrostomy and antegrade ureteral stenting. Eur Radiol. 2006.

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