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A ten-year, single institution experience with percutaneous nephrostomy during pregnancy

Published:November 09, 2020DOI:https://doi.org/10.1016/j.clinimag.2020.11.016

      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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