Nephrostomy in pregnancy a district general hospital experience over five years

Abstract

Background: Obstructed kidney is also termed hydronephrosis. An obstructed kidney produces buildup of urine within the kidney which increases pressure within the kidney. This condition can be a result of several different causes of which pregnancy is one of them. Obstructed kidneys in pregnancy call for relieving by nephrostomy which is a thin, plastic tube (catheter) that is inserted through the skin on the back and into the kidney. It can relieve a build-up of urine in the kidney and prevents the kidney from being damaged. It drains urine directly from one or both kidneys into a collecting bag outside the body. The bag has a tap so it can be emptied. Aims: To find out the rate of nephrostomy tube insertion in pregnant women in North Manchester General Hospital between January 2009 -December 2013. To identify problems that emanated from insertion of the nephrostomies. Results: Fifteen patients out of 24,863 deliveries (0.06%) in our catchment area underwent 17 nephrostomy procedures. All the nephrostomy insertions were successfully and safely undertaken. There was no immediate complication. The complications that were noted include: subsequent blockage of nephrostomy tubes which required readmission to flush the tubes to render them patent, two nephrostomy tubes subsequently fell out which were replaced, there was 1 minor infection which was treated by oral antibiotics. Surgical causes of obstruction found at post-partum nephrostogram include calculi and ureteric strictures which were managed post-partum. All the pregnancies continued to full-term with delivery of normal full-term babies. Conclusions: Percutaneous nephrostomy insertion in the pregnant woman under ultra-sound scan guidance is a safe and effective procedure associated with minimal complications and this allows pregnancy to continue to full term. The fact that the blocked nephostomies could all be flushed easily to unblock the tubes would indicate that if all district nurses are taught how to carefully flush nephrostomies readmission with blocked nephrostomies would be minimised. Strict adherence to nephrostomy protocol would partly help reduce complications associated with nephrostomy insertion in pregnancy.

Is Ultrasound-Guided Percutaneous Nephrostomy Efficacious and Safe in Pregnant Patients?: A Single Center Experience

“…Numerous studies have demonstrated the effectiveness and reliability of PCN placement in the general population; nonetheless, only a few studies with a limited number of patients have reported the effectiveness of ultrasound-guided PCN placement in pregnant women 10,11 Several published studies have reported data from sample sizes ranging between 1 and 52 on the application of PCN placement during pregnancy; however, a combination of fluoroscopy and ultrasound was frequently utilized in these studies [1][2][3]12 . The potential adverse effects of radiation on the fetus are well established 1 .…”

“…It usually presents as a mild condition and is generally accepted as a physiological process 1 . Factors such as the pressure of the uterus, iliac artery, or dilated uterine veins on the ureter, reduction in ureteral smooth muscle peristalsis due to hormonal effects, and the presence of kidney stones are considered potential etiological factors for pregnancy-related hydronephrosis 2 . While the majority of physiological hydronephrosis cases remain asymptomatic, it can progress in some instances, resulting in symptoms such as flank pain, hematuria, proteinuria, acute kidney failure, and severe urinary tract infections 1,2 .…”

“…Factors such as the pressure of the uterus, iliac artery, or dilated uterine veins on the ureter, reduction in ureteral smooth muscle peristalsis due to hormonal effects, and the presence of kidney stones are considered potential etiological factors for pregnancy-related hydronephrosis 2 . While the majority of physiological hydronephrosis cases remain asymptomatic, it can progress in some instances, resulting in symptoms such as flank pain, hematuria, proteinuria, acute kidney failure, and severe urinary tract infections 1,2 . Mildly symptomatic patients can be managed conservatively with pain relievers and/or antibiotics, while cases with significant obstruction may require procedures like percutaneous nephrostomy (PCN) placement or ureteral stenting 1 .…”

Management of urolithiasis in pregnancy

“…However, 2 patients had blocked nephrostomies, whereas 2 patients had nephrostomies that fell out. [46] There was an instance of infection that required oral antibiotics in one of the patients. Similar to ureteric stent, nephrostomy encrustation is an issue.…”

Complications of endourological procedures and their treatment

“…Different techniques can be used for insertion of PCN. The most commonly used techniques are either Seldinger's technique which include puncture of kidney by a needle then insertion of guide wire and dilatation over this wire to form a wide track enough for passage of nephrostomy catheter or one-stab technique (Bonnano Technique) using a pigtail Teflon catheter mounted on a hollow 18G needle which has a sharp beveled edge to be directly inserted in the pelvicalyceal system (3). PCN insertion can be either under ultrasound (US) guidance or combined US and fluoroscopy guidance.…”