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Urology/blockage at nephrostomy site


QUESTION: Hello, I have a temporary nephrostomy bag and a double j stent which are being reomoved hopefully in about ten days.  For the past couple of days I have seen white flakes in my nephrostomy bag and very tiny peices of sediment, also one fleck which looked bloody.  I am on a low dose of antibiotics as I have only one kidney, the other is atrophic, FURADANTINA mc 100, one a day.  What could the stuff in my bag be?. I do not have a temperature and my bp is good. I am a bit unsure as to whether or not I should go to the emergency room as I was told that the bag needs to be very cloudy or very red with blood, but to me, that sounds too extreme.  Please let me know what you think it could be.
Thank you.

ANSWER: Hazel,
We have different renal debris that is voided through the nephrostomy tube. With out looking at it under a scope I could not definitivly tell you what it is. Most likely just tissue that has devascularized and sloughed off .

---------- FOLLOW-UP ----------

QUESTION: Hello, since my last post, I had my nephrostomy bag removed and the double j stent.  The stent was first to be removed and then the urologist performed an injection of nuclear tracer into the nephrostomy site to my kidney to see how fast it passed through, well it didnt pass, it stopped ,so he had to force more through until it made its way through my bladder.  He didnt know why it had not passed, but said that on one of the imaging devices he could see that there was a bowl shaped image at the opening of the ureter,but he doesnt know what it is but he knew it wasnt cancer.  He also told me that only half of the width of my ureter is passing urine and he had to put another double j stent in for another month.  Apparently the wall of the ureter is quite thick - what does all this mean?  What could the bowl shape be, why is the ureter thick? Could they be temporary as a result of the pyeloplasty?    Thank you in anticipation.  Hazel

Any time a stent is in place there is a degree of edema (swelling) as a result of the foreign object being present and aggravating the tissue. The bowl shape observed at the ureteral orifice is usually swelling , I have  observed patients with the condition after minor laser scatter had contacted the tissue during a PVP (prostate surgery) procedure. We prescribed a medrol pack (corticosteroid)  afterwards to reduce the inflammation and the bowl disappears. A thickened ureteral wall just means tissue swelling in most cases. Apparently your body does not like the stent and this is its defense mechanism. The problem is that mechanism is also what can hurt you and cause hydronephrosis (blocked kidney) so the stent is the lesser of two undesirable scenarios. Give it time and this should resolve itself.  


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Thomas A Suppe RDMS CLT


Invervential urologic radiology , urologic laser surgery, cryotherapy of the prostate and kidney, extracorporal shockwave lithotripsy, holmium laser lithotripsy, urodynamics (video-non video),male infertility, erectile dysfunction, Peyronies disease, hypogonadism ,kidney stones, prostate cancer detection, BPH, voiding dysfunction, bladder cancer and continent diversions.


For the past 20 years performing intervential and diagnostic uro-radiology for a multitude of urologic surgeons from New York, New Jersey, Lousianna and Texas. Founder of DMS medical LLC introducing the Texas Medical Center to the first high power Green Light laser for the treatment of BPH just after its release by the FDA from Laserscope and its sucessful trials at the Mayo Clinc.

American Registery of Diagnostic Medical Sonographers (ARDMS), American Urologic Assocoation (AUA), American Medical Systems (AMS) Laserscope,Oncura, Allergan and Auxilliam pharmaceuticals.

Comprehention of Urologic Ultrasonography for the Resident Physician (Journal of Urology 2012), Author of the syllabus for the uro-radiology residency course at The Scott Dept of Urology at Baylor College of Medicine Houston Texas (2010 to present). Past Clinical Studies: Principal radiology investigator Allergan Inc for "The treatment of BPH with intra-prostatic injections of Botox" with Larry I Lipshultz MD 2011-2012, principal radiology investigator for Allergan Inc for "The treatment of Peyronies disease by intra-lesional penile injections of Botox" with Mohit Khera MD MBA MPH (2011-2012). Current studies: Principal investigator of "Blood pressure risk factors of intra cavernosal injections of Trimix and PGE1 during Penile Duplex's.

BS from Ramapo College of NJ, Registered diagnostic medical sonographer with the ARDMS, 2 year fellowship of Uro-Radiology and intervential sonography at Baylor College of Medicine Houston TX, laser safty officer in state of Texas and certified in KTP, Holmium and Lithium Tri-boride laser systems from Laserscope San Jose, California and American Medical Systems Minnatonka Minnasota, trained and certified by Oncura Inc Isreal in ultrasound guided argon cryotherapy of the prostate and kidney.

Awards and Honors
Honorary instructor of GU ultrasound course 2012 international meeting of the American Urologic Association. Author of the the AUA course for "Ultrasonography of the Testes and Scrotum" 2012.

Past/Present Clients
Baylor College of Medicine (BCM) Lousianna State University (LSU), LSU Medical Center Shreeveport LA, The Methodist Hospital Houston Texas, St Lukes Episcopal Hospital Houston Texas, Memorial Herman Health Systems Houston Texas, Palestine RMC Texas, Doctors Regional Hospital Corpus Christi Texas, Valverde Regional Medical Center DelRio Texas, Current instructor/technologist for two internationally recognized urologists : Larry I Lipshultz MD and Mohit Khera MD, MBA, MPH at Baylor College of Medicine. I served as intervential sonography consultant for Oncura Inc cryotherapy systems. Former lead trainer for Urosource mobile medical services , training new surgeons in PVP or photo-selective vaporization of the prostate for BPH, BNCs and urethral stricture vaporization.

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