Urology

Kidney drain (insertion, replacement)

What does this procedure entail?

The procedure is based on inserting a thin plastic tube through the skin into the kidney (usually under local anaesthesia). The tube drains urine from the kidney into the urine collection bag.

What are the alternatives to this procedure?

• Observation – follow-up
• Introduction (if possible) of internal drainage (stent) under general anaesthesia
• Open surgery – access to the kidney via an incision through the abdominal wall

What should I expect before this procedure?

If you regularly use Anopyrin, Clopidogrel, Warfarin, etc., you must tell your doctor. These medications can be associated with increased risk of bleeding during and after the surgery if they are not stopped in time. In some cases, it is necessary to replace these drugs with injection preparations. It is necessary to consult your general practitioner or cardiologist about this approach.
You will be admitted by a nurse and a member of the medical team will complete your examination and assess your fitness for the surgery.

Remember to inform your physician about the following possible facts before the surgery:

• artificial heart valve
• coronary artery stent
• pacemaker
• artificial joint
• artificial vascular graft
• neurosurgical bypass
• other implanted foreign body
• use of the following prescription drugs: Acylpyrin, Anopyrin, Aspirin, Godasal, Clopidogrel, Plavix, Kardegic, Aspegic, Micristin, Ibustrin,Ticlid, Tagren, Ipaton  Apo-Tic, Plavix, Persantin, Curantyl, Anturan, Aggrenox, Vessel due F.
• pharmaceuticals and other allergies, especially to contrast agents used in X-ray examinations
• any abnormalities or eventualities

It is NECESSARY to inform the physician about your use of drugs affecting blood clotting before your admission for the procedure.

What will happen during the surgery?

You will normally receive an injection or oral antibiotics before the procedure, but any allergies must be checked first. The procedure is usually performed under local anaesthesia; sometimes analgesic agents are administered into a vein.

You will lie on your stomach slightly bent forward. The procedure is performed under X-ray visualisation and an ultrasound probe is used to accurately target the puncture. After skin anaesthesia and needle insertion into the kidney, a wire is inserted through the needle and, after the canal is widened, a thin plastic tube is inserted into the kidney. Its correct position in the kidney is ensured by fixing a loop at its end. Sometimes, the tube is fixated to the skin via sutures. The procedure itself usually takes 20-30 minutes (but it may be longer especially depending on local conditions).

Replacement procedures are usually simpler and consist of inserting the wire into the existing drain (under X-ray visualisation) a new drain is inserted over the wire and after removing the old drain.

What will happen immediately after the procedure?

You will remain in bed for a few hours until you feel well, and you will be monitored by your nurse (the amount of urine – possibly timely emptying of the collection bag, blood pressure, heart rate, etc.) Quick movements that could pull the drain out should be avoided.

You should:

• ask if the planned outcome was achieved
• inform the medical staff about any problems
• ask what you can and cannot do
• ask all the questions you have for the healthcare professionals and members of the medical team.
• remember (and understand) why the surgery was performed, how it turned out, and what will follow

What are the postoperative risks or complications?

Common (10% of procedures of this type)

• Mild kidney bleeding (visible in the urine collection bag)
• Short-term discomfort in the area of the kidney and skin puncture

Occasional (2-10% of procedures of this type)

• leakage of urine around the catheter into the abdomen
• catheter occlusion
• general infection (septicaemia – 'blood poisoning') after tube insertion
• catheter replacement may be complicated by the deposition of urinary salts and drain occlusion or the formation of these deposits in the form of a stone on a loop in the kidney, thus complicating the opening of this loop

 Rare (2% of procedures of this type)

• significant abdominal bleeding requiring intensive treatment / surgical revision
• tube dislocation
• failure / impossibility of successful insertion of the tube into the kidney requiring another approach (e.g. surgical insertion)
• accidental injury to neighbouring organs (e.g. stomach, intestines)

 Hospital infections

• MRSA colonisation (0.9% – 1 of 110)
• Intestinal infection by clostridium difficile (0.01% – 1 of 10,000)
• MRSA blood infection (0.02% – 1 of 5,000)
• Hospital infection rates may be higher in high-risk patients, such as in cases requiring long-term drainage, after a previous infection, after prolonged hospitalisation or after multiple hospitalisations.

What should I expect when I return home?

When you are discharged from the hospital, you should:

• get recommendations on recovery at home
• ask when you can return to normal activities such as work, exercise, driving, housework
• get a contact number for further questions after returning home or in case of trouble
• ask about the date of the following check-ups and the place where you should come (hospital or your attending physician)
• make sure you are aware of the reason, course and outcome of the surgery, the results of examinations or the removal of tissues or organs.

At your departure from the hospital (sometimes several days later), you will receive a hospitalisation report. The document contains important information about your hospital stay, your surgery and recommended follow-up. If you need to call your attending physician or visit the hospital for any reason, take this document with you so that the physician knows the details of your treatment. This is especially important if you need to consult another doctor or longer after discharge.

The drainage tube may remain inserted for a period determined by your urologist.

Keep the skin around the tube clean and use a sterile bandage at least until the insertion site has healed (must be changed at least twice a week or when damp).

You can take a bath or shower 48 hours after the procedure, but try to keep the area around the insertion site dry. You will be able to shower without restrictions after 14 days.

What else should I watch out for?

In case of high fever, pain in one side of the lower back region, redness or swelling around the tube, leakage of urine around the tube, little or no flow of urine into the collection bag, or if the tube falls out, you must contact your doctor/urologist immediately.

Any important information?

Follow-up by a urologist will be necessary during the time you have the tube inserted. They will also provide you with the necessary information regarding further treatment.

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