Medical Student University of Miami Miller School of Medicine
Introduction: In complicated cases of maternal nephrolithiasis, placement of a percutaneous nephrostomy tube (PCN) or ureteral stent for temporary drainage is recommended. Although there have been small institutional and case series studies to compare each intervention’s complication rates, there is a paucity of literature doing so using a large database. We therefore investigated complication rates in the use of PCNs versus ureteral stents in the treatment of maternal nephrolithiasis using a multi-institutional, national claims database.
Methods: We queried the TriNetX network database: a global health research network consisting of 65 million patients in 44 healthcare organizations. Pregnant women (ICD-10 Z34, O09) with a history of complicated maternal nephrolithiasis (N20-23) who underwent a PCN (CPT 50432) or ureteral stent (52332) placement within 6 months of pregnancy diagnosis were evaluated for incidence of any additional inpatient admission, premature labor or delivery (O42, O60), exchange procedure (52332, 52310, 52315, 50387, 50432, 50435), new UTI or pyelonephritis (N39.0, O23, N10), or refractory nephrolithiasis (N20-23) within 1 week to 6 months of their initial procedure. We controlled for the following potentially confounding variables through propensity-score matching: age, race, ethnicity, and previous pyelonephritis or sepsis (N10, O23, A41).
Results: We identified 883 pregnant women who underwent ureteral stent placement and 136 who underwent PCN. Within 6 months of their initial procedure and following propensity score matching, significantly less women with a ureteral stent experienced a new UTI or pyelonephritis (aOR 0.37; 95% CI 0.15-0.94; p=0.0351) compared to those who underwent PCN placement. Ureteral stent placement was also associated with a significantly decreased rate of hospital admissions (aOR 0.37; 0.22-0.61; p<0.0001) and less need for repeat ureteral stent or PCN (aOR 0.47; 0.29-0.78; p=0.0028). There was no difference in rates of premature labor or delivery (aOR 0.83; 0.41-1.66; p=0.5936), or refractory nephrolithiasis (aOR 0.87; 0.42-1.80; p=0.1259).
Conclusions: In maternal nephrolithiasis, ureteral stent placement was associated with a lower incidence of hospital admissions, exchange procedures, and new UTIs or pyelonephritis. Although further studies are needed to assess differences in temporality and severity of disease post-procedure, this study assists providers in weighing clinical risks and benefits in the treatment of complicated maternal nephrolithiasis.
Source of Funding: This work was supported by National Institutes of Health Grant R01 DK130991 from the American Cancer Society to Ranjith Ramasamy.
.jpg)
.jpg)
