University of Miami Miller School of Medicine, Miami, FL, USA.
Department of Urology, Yale University School of Medicine, New Haven, CT, USA.
World J Urol. 2023 Jul;41(7):1721-1726. doi: 10.1007/s00345-022-04111-2. Epub 2022 Jul 31.
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.
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.
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).
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.
研究经皮肾造瘘管（PCN）与输尿管支架治疗妊娠肾结石相关不良妊娠事件的发生率。
我们查询了 TriNetX Diamond 网络数据库，以评估有肾结石病史（N20-23）的孕妇（ICD-10 Z34，O09），这些孕妇在分娩前 6 个月内接受了 PCN（CPT 50432）或输尿管支架（52332）置入术。我们通过倾向评分匹配控制了以下可能的混杂变量：年龄、种族、民族、急性肾盂肾炎（N10）、妊娠时生殖道感染（O23.0）和其他败血症（A41）。
我们共确定了 2999 名接受输尿管支架置入术的孕妇和 321 名接受 PCN 治疗的孕妇。经倾向评分匹配后，我们发现早产或分娩率（优势比 1.08，95%置信区间 0.735-1.588）、胎膜早破（0.889，0.453-1.743）、宫内感染（0.906，0.379-2.165）或剖宫产（0.825，0.408-1.667）均无显著差异。在最初手术的 6 个月内，接受输尿管支架的女性发生后续尿路感染或肾盂肾炎的发生率显著降低（0.52，0.38-0.71）、住院率（0.40，0.26-0.64）、急诊就诊率（0.65，0.48-0.89）和重复更换手术率（0.70，0.51-0.96）。
在妊娠肾结石的治疗中，PCN 与输尿管支架置入术在不良妊娠事件发生率方面无显著差异。然而，输尿管支架置入术与较低的住院率、急诊就诊率、更换手术率以及新发尿路感染或肾盂肾炎发生率相关。
