04:03 PM Abstract No. 418 Retrospective analysis of percutaneous nephrostomy catheter placement in pregnant patients

Abstract

To report the experience of percutaneous nephrostomy (PCN) drainage in pregnant patients at a tertiary women’s care hospital. 49 pregnant patients receiving PCN catheters in 52 pregnancies between 2008 and 2018 were identified, with 41 followed to delivery. Procedural parameters and delivery outcomes were assessed. A total of 52 catheters were placed--42 (81%) right, 8 (15%) left, and 2 (4%) bilateral. Mean gestational age at placement was 27.1 weeks. 22 (42%) were placed for pain, 19 (37%) for obstructing calculi, 10 (20%) for pyelonephritis, and 1 (2%) for obstructing endometrioma. 40% of patients had prior placement or attempted placement of a ureteral stent. Conscious sedation was used in 31 (61%) patients, pain control and local anesthesia in 13 (25%), general anesthesia in 6 (12%), and spinal anesthesia with conscious sedation in 1 (2%). Mean fluoroscopy time was 3.19 minutes for average catheter exchange, 6.46 minutes for difficult exchange, and 1.57 minutes for easy exchange. For patients receiving PCN for pain, 73% (and 100% without prior ureteral stent) had complete or significant resolution of their pain. Mean number of exchanges was 1.6 with a range from 0 to 9 and a mean 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. 8 (15%) catheters required new PCN placement due to either dislodgement or significant obstruction; the only other complication was a single case of self-limiting extravasation from the renal pelvis. Of the patients followed to delivery, mean gestational age at delivery was 37.6 weeks. 14 (34%) patients had complications of pregnancy with fetal demise in one patient. PCN drainage is a safe and effective treatment for managing ureteral obstruction in pregnant patients. Pregnancy poses unique challenges given the risks of anesthesia and radiation to the fetus, which can be minimized in patients able to tolerate the procedure without sedation. Additionally, rapid encrustation of the catheter seen in pregnancy tends to recur in the same patients and requires more frequent exchanges than the general population.