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 thekidney which increases pressure within the kidney. This condition can be a result of several different causes of which pregnancyis one of them. Obstructed kidneys in pregnancy call for relieving by nephrostomy which is a thin, plastic tube (catheter) that isinserted through the skin on the back and into the kidney. It can relieve a build-up of urine in the kidney and prevents the kidneyfrom being damaged. It drains urine directly from one or both kidneys into a collecting bag outside the body. The bag has a tapso it can be emptied.

Aims: To find out the rate of nephrostomy tube insertion in pregnant women in North Manchester General Hospital betweenJanuary 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. Allthe nephrostomy insertions were successfully and safely undertaken. There was no immediate complication. The complicationsthat were noted include: subsequent blockage of nephrostomy tubes which required readmission to flush the tubes to renderthem patent, two nephrostomy tubes subsequently fell out which were replaced, there was 1 minor infection which was treatedby oral antibiotics. Surgical causes of obstruction found at post-partum nephrostogram include calculi and ureteric strictureswhich 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 effectiveprocedure associated with minimal complications and this allows pregnancy to continue to full term. The fact that theblocked nephostomies could all be flushed easily to unblock the tubes would indicate that if all district nurses are taught how tocarefully flush nephrostomies readmission with blocked nephrostomies would be minimised. Strict adherence to nephrostomyprotocol would partly help reduce complications associated with nephrostomy insertion in pregnancy.