Percutaneous nephrostomy (PCN) is a minimally invasive procedure performed in specialized hospitals. Although the term sounds intimidating, modern techniques have made it safe and short-lived — with a hospital stay of 1–2 days in most cases.
If you don't know exactly what a nephrostomy is or when it is done , start there. For an overview, read the complete care guide .
Preparation before surgery
- Fasting for 6–8 hours before surgery.
- Discontinuation of anticoagulants (Sintrom, Plavix, NOACs) after consultation with the doctor — usually 3-5 days before.
- Preoperative examination: complete blood count, biochemical, coagulation, urine culture.
- Prophylactic antibiotics 30-60 minutes before the puncture.
- Obtaining signed consent after risk-benefit information.
Anesthesia
The most common form is local anesthesia in the lumbar region, often combined with light intravenous sedation. In children, uncooperative patients, or in complex cases, general anesthesia is used.
With local anesthesia, the patient is awake but does not feel pain. Cooperation (breathing on command) facilitates the interventional radiologist.
Steps of the procedure
1. Patient positioning
The patient is placed in the prone or 30° lateral position. The lumbar region is exposed and cleaned with an antiseptic (usually chlorhexidine solution or povidone).
2. Imaging guidance
The ideal puncture site is identified by ultrasound or fluoroscopy. The goal is a smaller pelvis (calyx) at the lower pole of the kidney — a safer route with less risk of bleeding.
3. Puncture
Using a thin needle (Chiba type, 18 or 21 G), the physician punctures the skin and advances under imaging control to the pelvis. Proper entry is confirmed by urine flowing from the needle.
4. Guidewire
A thin wire (guidewire) is inserted through the needle, secured in the pelvis. All subsequent instruments will slide over it.
5. Dilation of the tract
Progressively larger dilators are used to open the tract from the skin to the pelvis to accommodate the final catheter.
6. Catheter placement
The catheter (usually 8-14 Fr with a coiled tip) is slid over the wire. When in the correct position, the coiled tip is formed in the pelvis and anchors the tube.
7. Stabilization and connection
The catheter is secured with a suture to the skin or with a StatLock adhesive system. It is connected to an initial drainage bag. Dressings and a transparent waterproof film cover the exit site.
Duration
Total: 30–60 minutes for uncomplicated cases. More complex cases (obese patients, non-enlarged kidney, anatomical variations) may take longer.
After surgery
- Hospital stay 24–48 hours for observation.
- Initially, the urine may be bloody — this is expected and resolves in 24–72 hours.
- Mild lower back pain that is controlled with common painkillers.
- Ultrasound examination to exclude hematoma.
- Patient and family education on bag care.
- Discharge from hospital when urine is clear and vital stability confirmed.
Potential risks
The procedure is considered safe but any invasive procedure has risks. Serious complications <2% and include: significant bleeding (1-2%), injury to adjacent organs (<1%), pneumothorax at high punctures (<1%), sepsis (usually when infection was present).
Success rates
In enlarged kidneys (hydronephrosis), successful placement rates exceed 98%. In non-enlarged kidneys (a rarer indication), the rates drop to 90%.
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Sources: Hellenic Society of Interventional Radiology, General Hospital of Patras, Government Gazette B' 5395/2025. Informational article, not a substitute for medical advice.