Interventional urology

Each kidney makes urine all day long. The urine collects in a funnel inside the kidney, then travels down a narrow tube called the ureter to the bladder. If something blocks the ureter, urine backs up and the kidney swells. Doctors call this swelling hydronephrosis.

A blocked kidney can cause pain in your side or back, nausea, and less urine. Sometimes it causes no symptoms at all and is found on a scan. Over days to weeks, the pressure can damage the kidney. If the trapped urine becomes infected, it can spread to the blood. This is called sepsis, and it is an emergency.

What we see

Interventional radiologists use live X-ray and ultrasound to guide thin tubes through a small nick in the skin of your back and into the kidney. There is no surgical cut. Most procedures take 20 to 60 minutes under moderate sedation, which means medicine through an IV that makes you relaxed and drowsy while you keep breathing on your own.

Urologists (surgeons who treat the urinary tract) can often place a stent from below, through the bladder, using a small camera. We work closely with them. The route from the back is a good choice when the path from below is blocked, when you are too sick for anesthesia, or when the kidney needs to be drained quickly because of infection.

Which tube you get depends on where the blockage is, whether a wire can be passed through it, whether there is infection, and how long you are likely to need help.

Often these tubes are steps along one path. A person with an infected, blocked kidney may start with a nephrostomy tube. Once the infection clears, we may change it to a nephroureteral stent, then to a fully internal ureteral stent, and later remove everything when the cause is fixed.

When I look at the CT or ultrasound, the first question I ask is whether the kidney is infected. If it is, I drain it first and save the fancier plan for later, because a simple tube can be lifesaving. After that, I try to get patients to the option that fits their daily life best, and for most people that means as little outside tubing as possible.

Fabio Komlos, MD, interventional radiologist · About Dr. Fabio Komlos

Most people go back to normal daily life within a day or two. You can shower, walk and work. Tubes that leave the body need a clean dressing and a bag that hangs below the kidney. All tubes need to be changed on a schedule because minerals from urine slowly build up inside them. We will book these changes for you.

Our guide on managing your drain covers everyday care, and home supplies lists bags, holders and dressings that make life easier.