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A comparison of adverse pregnancy events between ureteral stents and percutaneous nephrostomy tubes in the treatment of nephrolithiasis during pregnancy: A propensity score-matched analysis of a large multi-institutional research network

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A Letter to the Editor to this article was published on 22 December 2022

Abstract

Purpose

To investigate rates of adverse pregnancy events associated with the use of percutaneous nephrostomy tubes (PCN) versus ureteral stents in the treatment of nephrolithiasis during pregnancy.

Methods

We queried the TriNetX Diamond Network database to evaluate pregnant women (ICD-10 Z34, O09) with a history of nephrolithiasis (N20-23) who underwent a PCN (CPT 50432) or ureteral stent (52332) placement up to 6 months before delivery (O80-82). We controlled for the following potentially confounding variables through propensity score matching: age, race, ethnicity, acute pyelonephritis (N10), infections of the genitourinary tract in pregnancy (O23.0), and other sepsis (A41) at the time of stent or PCN placement.

Results

We identified 2,999 pregnant women who underwent ureteral stent placement and 321 who underwent PCN. Following propensity score matching, we found there to be no significant difference in the rate of premature labor or delivery (aOR 1.08, 95% CI 0.735–1.588), premature rupture of membranes (0.889, 0.453–1.743), intrauterine infection (0.906, 0.379–2.165), or c-Sect. (0.825, 0.408–1.667). Within 6 months of their initial procedure, women with a ureteral stent experienced a significantly decreased rate of subsequent urinary tract infection (UTI) or pyelonephritis (0.52, 0.38–0.71), inpatient hospital stay (0.40, 0.26–0.64), emergency department visit (0.65, 0.48–0.89), and repeat exchange procedure (0.70, 0.51–0.96).

Conclusion

In the treatment of nephrolithiasis during pregnancy, PCN versus ureteral stent placement does not confer a significant difference in rates of adverse pregnancy events. However, ureteral stent placement was associated with a lower incidence of hospital admissions, emergency department visits, exchange procedures, and new UTIs or pyelonephritis.

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Funding

This work was supported by National Institutes of Health Grant R01 DK130991 and 194 Clinician Scientist Development Grant from the American Cancer Society to Ranjith Ramasamy.

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Authors and Affiliations

  1. University of Miami Miller School of Medicine, Miami, FL, USA

    Matthew M. Mason, Sirpi Nackeeran & Marisa R. Carino Mason

  2. Department of Urology, Yale University School of Medicine, New Haven, CT, USA

    Soum Lokeshwar

  3. The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Taylor Kohn

  4. Department of Urology, Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, Room 1560, Miami, FL, 33136, USA

    Hemendra N. Shah & Ranjith Ramasamy

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  1. Matthew M. Mason
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  4. Marisa R. Carino Mason
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  7. Ranjith Ramasamy
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Contributions

MMM: Project development, manuscript writing. SN: Project development, data collection, data analysis, manuscript writing. SL: Manuscript editing. MRCM: Manuscript editing. TK: Project development, manuscript editing. HNS: Manuscript editing. RR: Project development, manuscript editing.

Corresponding author

Correspondence to Ranjith Ramasamy.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

Ethical approval was waived by the local Ethics Committee of University of Miami in view of the retrospective nature of the study. TriNetX has received an Institutional Review Board waiver and provides only de-identified patient data, with additional limitations placed on database queries to protect patient privacy.

Consent to publication

This was an observational study based on analyses of anonymized electronic medical records. No intervention or any study specific activity was done. Therefore, no informed consent was required.

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Mason, M.M., Nackeeran, S., Lokeshwar, S. et al. A comparison of adverse pregnancy events between ureteral stents and percutaneous nephrostomy tubes in the treatment of nephrolithiasis during pregnancy: A propensity score-matched analysis of a large multi-institutional research network. World J Urol 41, 1721–1726 (2023). https://doi.org/10.1007/s00345-022-04111-2

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