The diagnosis that leads to a nephrostomy usually comes unexpectedly. Whether as an emergency intervention to relieve a blocked kidney or as a long-term solution when a normal urinary tract is not possible, a nephrostomy changes many things in everyday life — but less than one might expect.
In this guide, you will find everything you need to know: what exactly a nephrostomy is, what its indications are, how it is placed, and — most importantly — how to properly care for the tube and bag at home. We also cover what EOPYY covers, what are the possible complications, and when you should call your doctor.
Important: This article is for informational purposes only. It does not replace the advice of your doctor or nurse. For any symptoms or questions, contact your doctor.
What is nephrostomy
Nephrostomy — or more specifically percutaneous nephrostomy (PCN) — is a medical procedure in which a thin tube (catheter) is placed through the skin into the renal pelvis. Its purpose is to drain urine directly from the kidney into an external collection bag, when the normal path through the ureter and bladder is blocked or for some reason cannot be used.
The catheter is made of a biocompatible material (usually polyurethane or silicone) and has a spiral end (“pigtail”) inside the kidney that stabilizes it. On the outside, it is connected to a urine collection system—a bag that can be portable (leg bag) or stationary (night bag).
A nephrostomy can be temporary (from a few days to a few weeks) while the cause of the obstruction is treated, or permanent when the cause is not reversible. In this case, the catheter is changed every 8 to 12 weeks to prevent salt buildup and blockages.
When is a nephrostomy needed
A nephrostomy is placed when there is a blockage in the ureter or renal pelvis that prevents the normal flow of urine to the bladder. If the accumulation continues, the kidney swells (hydronephrosis) and — if not decompressed promptly — may be irreversibly damaged.
The main indications
- Ureteral or pelvic stones causing total obstruction and hydronephrosis.
- Tumors (ureteral, bladder, pelvic, prostate, or gynecological tumors) that externally compress the ureter.
- Trauma or accidental injury to the ureter during surgery.
- Acute pyelonephritis with sepsis requiring immediate drainage.
- Ureteral strictures after surgery or radiation.
- When a ureteral stent (double-J) cannot be placed or has failed.
How it is placed
The procedure is performed by an interventional radiologist or urologist in a special radiological or surgical support room. It is minimally invasive: the patient usually does not need general anesthesia but local with or without light sedation, and the total duration is around 30-60 minutes.
Steps of the procedure
- The patient is placed on his or her stomach or slightly on his or her side.
- The lumbar region is cleansed with an antiseptic and local anesthesia is applied.
- The kidney is punctured with ultrasound and/or fluoroscopy.
- A thin guidewire is inserted into the pelvis and the final catheter is placed over it.
- The catheter is secured with a suture to the skin and bandages.
- Urine drainage begins immediately.
After the procedure, the patient usually stays in the hospital for 24 hours for observation. They may experience mild pain in the lumbar region and notice hematuria (blood in the urine) for 24-48 hours — this is common and resolves. He returns home when his urine is clear and he has been trained in bag care.
Nephrostomy or ureteral stent?
These are two different approaches to the same problem — kidney drainage. A nephrostomy drains urine to the outside, while a stent (double-J) drains it internally to the bladder. Which is appropriate depends on the specific case.
Advantages of nephrostomy
- Immediate and guaranteed decompression — not dependent on ureteral patency.
- Ability to monitor urine volume/color from each kidney separately.
- Ability to administer drugs or lavages directly into the kidney.
Advantages of stents
- Not visible externally — no impact on body image.
- No daily care required by the patient.
- Allows for more free activities (swimming, exercise, etc.).
In practice, your doctor will choose based on the cause of the blockage, the patient's condition, the expected duration of treatment, and whether stent placement is technically possible.
Daily care — what to do at home
Proper care of the catheter and bag is the only factor you can control. Systematic hygiene dramatically reduces the risk of infection and blockage, which are the two most common complications.
Emptying the bag
The leg bag should be emptied when it is 2/3 full, so that it does not weigh down and pull on the catheter. Under normal conditions, this means 3-5 times a day. Before emptying, wash your hands with soap, open the drain valve into a clean toilet or special container, and close it again without touching the tip.
Bag change
The bag is changed every 5-7 days or sooner if it leaks, has an odor, or is cloudy. Always use aseptic technique: gloves, clean the connection with an alcohol swab, and dispose of the old bag in a medical waste bin (or in a double-sealed bag if one is not available).
Exit site care
The point where the tube enters the skin is called the “exit site” and needs to be checked daily. Use sterile gauze and an antiseptic (e.g., 2% chlorhexidine) to clean around the tube in a circular motion from the inside out. Then apply a new gauze and waterproof dressing. Modern transparent film dressings with chlorhexidine can be left in place for up to 7 days, significantly reducing the number of dressing changes.
Stabilization
A common mistake is to let the tube hang loosely. It should be secured to the skin with a special adhesive (e.g. StatLock) or tape to prevent it from being pulled out with sudden movements. A sudden pull can dislodge the catheter—an emergency requiring immediate return to the hospital.
Lifestyle with a nephrostomy
Bathing and showering
Showering is permitted when the exit site is well covered with a waterproof transparent film dressing. Avoid bathing in a bathtub, swimming in a pool or sea, and spa/sauna for the first 6 weeks, and always after consulting your doctor.
Travel
Patients with a fixed nephrostomy can travel, even by air. Preparation is needed: several replacement bags, antiseptics, gauze, scissors (we check the baggage regulations), and a medical certificate in English.
Nutrition and fluids
Proper hydration (1.5-2 liters of water daily, unless the doctor has prescribed otherwise) is the most basic “natural washing” of the catheter. A kidney-friendly diet (controlled sodium, moderate protein intake) slows the buildup of salts that can block the tube.
Exercise and activities
Light walking and simple daily activities are allowed from the second day. Avoid strenuous exercise, lifting more than 5 kg, and contact sports for 4–6 weeks. Gradually return to all activities, except swimming in a public pool while wearing a tube.
Possible complications — and when to call the doctor
With proper care, serious complications are rare. However, early recognition of the early signs is critical.
Infection
Signs to watch out for: fever >38°C, chills, back pain, cloudy or foul-smelling urine, redness/pus at the exit site. Urinary tract infection with nephrostomy can quickly progress to sepsis — seek medical attention immediately.
Blockage
If you notice that the bag does not fill for more than 4 hours or that fluid begins to leak from the exit site, the tube is likely clogged with salts or blood crusts. Do not attempt to flush it yourself unless you are trained.
Inadvertent removal
If the tube comes out partially or completely, wrap it in sterile gauze and go to the emergency room immediately. Within a few hours, the tract will close and need to be reinserted.
Urine leakage on the skin
Small leaks around the exit site may occur. Large or persistent leaks indicate either blockage or catheter displacement — evaluation by a doctor is required.
EOPYY coverage — what you are entitled to
Patients with nephrostomy are covered by the EOPYY Unified Health Benefits Regulation (EKPY), under ICD-10 codes Z93.6 (presence of an artificial urinary stoma) and Z43.6 (care of an artificial urinary stoma). According to the Government Gazette B' 5395/09-10-2025, EOPYY covers a 1 or 2-piece system with a maximum monthly cost of €270 and a patient participation of 0%.
Prescriptions are made electronically by the attending physician through the EOPYY eservices. The following are entitled to prescribe: Internist, Nephrologist, Surgeon, Pediatric Surgeon, General Practitioner, Urologist, Oncologist and Rural Doctor.
As a contracted EOPYY provider since 2014, Traumacare takes care of all the paperwork: you get the prescription from the doctor, send it to us electronically, and the materials are sent to your home by express courier next-day.
Frequently asked questions
How long does a nephrostomy catheter last before it needs to be changed?
Modern polyurethane or silicone catheters are typically replaced every 8-12 weeks. In case of complications (blockage, infection) the change is made earlier.
Does changing the catheter hurt?
Changing over a guidewire is relatively painless and takes 10-15 minutes under local anesthesia.
Can I travel by air?
Yes. Bring a medical certificate in English, several spare bags, and inform the security check before the scanner.
Is it covered by EOPYY?
Yes, fully for basic materials (bags, bases, pastes, antiseptics). Patient participation 0%, maximum cost 270€/month.
Can I swim in the sea?
Not while wearing a nephrostomy. The risk of infection from untested water is high. Showering with a waterproof dressing is safe.
Get all nephrostomy materials from an EOPYY contracted provider
Traumacare is the exclusive representative of B Braun Avitum in Greece and a distributor of Convatec products — companies with decades of experience in nephrostomy and urostomy care. We have a comprehensive range of materials with 100% coverage by EOPYY and delivery throughout Greece. Our team with 20+ years of experience will guide you in the selection and will take care of the prescription.
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Sources: Government Gazette B' 5395/09-10-2025, Unified Regulation of Health Benefits EOPYY, Nursing Care of a Patient with Percutaneous Nephrostomy (Patras General Hospital). The article is informative and does not replace medical advice. Last updated: May 2026.