Percutaneous nephrostomy tubes in pregnancy: a multi-institutional experience.

Renal colic in pregnancy poses challenges from initial imaging modality to need for urgent decompression and subsequent management. Each decision carries risks for mother and fetus. We share our multi-institutional experience with percutaneous nephrostomy tubes (PCNs) in pregnant patients with suspected renal colic. Pregnant patients with suspected renal colic initially managed with PCNs were identified at two institutions from 2011-2025. Retrospective chart review included demographics, obstetric history, imaging, radiation exposure, and other clinical outcomes. Descriptive statistics identified clinical trends. Of 55 included patients, mean age at presentation was 29.7 ±5.6 years with gestational age of 24.1 ±8.2 weeks. Bilateral PCNs were placed in 9 (16.4%) patients, 5 (9.1%) patients previously experienced preterm birth, and 31 (56.4%) patients had prior stones. Readmissions were common, with 33 (60%) patients readmitted for PCN malfunction, 26 (47.3%) patients for pyelonephritis, and 28 (50.9%) patients for pain. Thirty-eight patients underwent at least one PCN exchange, with a mean of 2.3 ±2.8 exchanges per patient at an interval of 29.5 ±17.2 days. Of 128 PCN exchanges, 71 (55.4%) were complicated, with 48 (37.5%) performed for blockage or encrustation. Mean cumulative radiation exposure over the pregnancy was 178.8 ±330.9 mGy. Sixteen (29.1%) patients had PCNs removed during ureteroscopy for definitive treatment, while 11 (20%) patients experienced preterm birth. PCNs in pregnancy carry risks, including readmissions, complicated exchanges, radiation exposure, and preterm birth. We highlight the need for optimized management that coordinates care across specialties, improves patient selection, and includes primary ureteroscopy when safe.