Open Placement of Nephrostomy Tube in Dogs

Nephrostomy is a surgical procedure that involves placing a nephrostomy tube in a calyx, which is a chamber of the kidney that carries urine to the renal pelvis. This is done to resolve renal obstruction and divert urine flow. Percutaneous nephrostomy, as opposed to open nephrostomy, is the surgical approach of choice. However, certain circumstances may contraindicate the percutaneous approach. In dogs with inoperable kidney tumors or other irresolvable conditions, the nephrostomy tube may be placed permanently.

1. Before surgery, a blood sample will be analyzed to ensure anesthetization is safe for the dog.
2. General anesthesia and pain management medications are administered intravenously throughout surgery.
3. The surgeon will shave, clean, and drape the operative area.
4. The surgeon will then surgically access and explore the kidney.
5. The renal pelvis is then opened, and the surgeon will determine the best calyx in which to place the nephrostomy tube.
6. Once placed, the surgeon will perform a nephropexy, which involves surgically fixating the kidney in its normal position.
7. A collection apparatus is attached so that the urine can drain naturally until the obstruction resolves. It will remain in place for at least four weeks.
8. The tube will then be passed through the body wall and sutured to the skin.
9. The dog will be hospitalized to ensure the tube does not dislodge or cause immediate postoperative complications.

It should be noted that open nephrostomy is no longer considered the first line of treatment for kidney conditions. This is attributed to the advent of the less invasive percutaneous approach. Nephrostomy tube placement, both surgical and percutaneous, has a high risk of postoperative complication, at over 50%. However, there is little information on nephrostomy tube placement in current veterinary literature. Other treatment methods may be required to fully treat the underlying condition.

Pet parents should follow the surgeon’s recovery instructions carefully. The dog may need to wear an Elizabethan collar to avoid damaging the surgical site. If owners notice swelling, bleeding, or discharge near the surgery site, or any other complications, they should consult their veterinarian immediately. A follow-up appointment will be scheduled for four weeks after surgery to remove the tube and reevaluate renal function. When the tube is removed, the initial hole in which the tube was placed will be sutured. This will require another bout of anesthesia. 

The cost of open placement of nephrostomy tube in dogs will vary based on standards of living and additional costs incurred. The price of open nephrostomy may range from $2,500 to $3,000.

The risk of complications with nephrostomy tube placement is high, especially in the open approach. Over 50% of dogs that undergo this surgery may experience postoperative complications. These include, but may not be limited to:

• Bleeding
• Infection
• Urine leakage
• Insufficient drainage
• Intraoperative trauma to the kidneys
• Tube dislodgement or damage
• Recurrence of the condition

The most common complications associated with this surgery are tube dislodgement and damage. The risk of postoperative complication is lower if the surgeon is highly skilled.

This procedure is rarely performed in modern veterinary practice. Percutaneous nephrostomy is considered the procedure of choice because it is less invasive, presents fewer postoperative complications, and requires only local anesthesia.

Some renal conditions are hard to prevent in dogs. A proper diet is imperative for preventing recurrence of kidney stones and other obstructions. Diets should be low in protein, magnesium, and phosphorus. Dogs with chronic and/or severe kidney conditions should not be bred.