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Percutaneous Nephrostomy (PCN) Tube

A percutaneous nephrostomy (PCN) tube provides external drainage of the renal collecting system via a tube placed percutaneously through the flank into the pelvicalyceal system. It is the first-line decompression method when internal (DJ) drainage cannot be placed or will not be adequate.

Design & Sizing​

  • Soft polymer catheter (polyurethane or silicone)
  • Pigtail or locking retention tip at the renal end
  • 8–14 Fr typical for routine drainage; up to 24 Fr for large-volume or heavily pus-containing systems
  • External connection to a bag or leg bag

Indications​

  • Obstructive uropathy with urosepsis — urgent decompression when retrograde cystoscopy is contraindicated or unsuccessful
  • Failed retrograde DJ stent placement (impacted stone, distal stricture, ureteral tortuosity)
  • Pre-operative drainage before stone surgery or ureteral reconstruction
  • Urinary leak diversion (urinoma, post-traumatic)
  • Nephropleural fistula or other upper-tract fistula management — see Nephropleural Fistula
  • Antegrade access for percutaneous nephrolithotomy (PCNL)
  • Nephrostogram for imaging the collecting system in obstruction

Placement​

  • Image-guided percutaneous puncture — ultrasound and/or fluoroscopy
  • Supracostal (above 12th rib) vs infracostal — supracostal access reaches upper-pole calyces but carries pleural injury risk, including nephropleural fistula
  • Seldinger technique with progressive dilation to tube size
  • Typically performed by interventional radiology; urologists also place in select settings

Advantages over Internal Stent​

  • Larger bore — better flow of pus or debris
  • Immediate decompression in septic obstruction
  • Accessible for exchange, irrigation, nephrostogram
  • No cystoscopy required — can be placed in the septic, bed-bound patient

Complications​

  • Bleeding — transient hematuria common; major bleeding (AV fistula, pseudoaneurysm) in 1–4%
  • Pneumothorax / hemothorax / pleural injury — from supracostal access
  • Tube dislodgement — particularly in early post-placement period
  • Infection — tract cellulitis, pyelonephritis
  • Tract tumor seeding — rare but documented in urothelial malignancy
  • Urine leak around the tube — dressing change and adhesive management

Dwell Time & Exchange​

  • Exchange every 8–12 weeks when chronic
  • Silicone tubes may tolerate longer dwell
  • Progressive encrustation limits practical dwell time

See also: Double-J Stent, Nephroureteral Stent, The Kidneys.