Highlights
- •In pregnant patients, unique challenges during nephrostomy placement, include anesthesia, radiation dose, and catheter encrustation.
- •Nephrostomy drainage is safe and effective in pregnancy; however, it is unclear if pain management alone is effective.
- •Nephrostomy is less effective in treating hydronephrosis-related pain in patients with pre-existing ureteral stents.
Abstract
Purpose
To evaluate the safety and efficacy of percutaneous nephrostomy (PCN) in pregnancy.
Materials and methods
PCN tubes were placed during 52 pregnancies in 49 patients from 2008 to 2018. The
medical records during pregnancies were retrospectively reviewed for imaging findings,
procedural parameters, outcomes of delivery, and complications.
Results
The mean gestational age on percutaneous nephrostomy placement was 27 weeks (range,
8–36 weeks). PCN catheters were placed for the following indications: 1) flank or
lower abdominal pain (42%), 2) obstructing calculi (37%), 3) pyelonephritis (20%),
and 4) obstructing endometrioma (2%). Prior to PCN, retrograde ureteric stenting was
performed in 17 of 49 patients (34%) and attempted but failed in 4 patients (8%).
Nephrostomy drainage relieved pain completely or significantly in all 12 patients
without prior ureteral stenting, but in only 4 of 10 with retrograde ureteric stents.
In one patient in whom the ureteral stent had been removed, PCN relieved her flank
pain. The mean number of PCN catheter exchanges was 1.6, ranging from 0 to 9, with
a mean time interval of 21.3 days between exchanges. There were 29 difficult exchanges
due to encrustation in 15 patients with a mean of 20.5 days between exchanges.
Conclusions
PCN drainage is a safe and effective treatment for managing symptomatic hydronephrosis
in pregnant patients but is less effective in treating pain when retrograde ureteral
stents are in place. Rapid encrustation, seen more commonly in pregnancy, tends to
recur in the same patients and requires more frequent exchanges than the general population.
Keywords
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Article info
Publication history
Published online: November 09, 2020
Accepted:
November 8,
2020
Received in revised form:
October 27,
2020
Received:
May 5,
2020
Footnotes
☆No funding was obtained for this study.
☆☆This study has not been previously published nor is under consideration elsewhere. An abstract by the same title was presented at the Society of Interventional Radiology annual meeting in 2019.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
