Nephrostomy tube dislodgement and emergency exchange: a study of clinical and age-related patient factors

Unplanned nephrostomy tube exchange is common, yet patient-level risk factors remain poorly defined. This study aimed to quantify emergency exchange rates and identify clinical and vulnerability-related predictors.

Adult patients undergoing nephrostomy placement or exchange in the period January 2021 to October 2024 were retrospectively reviewed. The first (index) procedure per patient was analyzed with up to 90-day follow-up. The primary outcome was emergency tube exchange; patency was time to emergency exchange. Multivariable logistic regression and Cox models identified associated factors.

A total of 108 patients were included; median age was 78 years (IQR 68-85) and 65% were male. Frailty (Clinical Frailty Scale ≥5) was present in 32%, and cognitive impairment in 10%. During follow-up, 49 patients (45%) required emergency exchange. The most common indications were partial dislodgement (49%), complete displacement (27%), and catheter obstruction (12%). Estimated tube patency was 70% at 30 days, 62% at 60 days, and 56% at 90 days. On multivariable logistic regression, cognitive impairment was independently associated with emergency exchange (OR 4.8, 95% CI: 1.1-21.0; p = 0.038). Age, sex, frailty, comorbidity burden, laterality, and functional dependence were not significantly associated. In Cox regression, cognitive impairment was also associated with reduced nephrostomy patency (HR 3.1, 95% CI: 1.3-7.2; p = 0.01).

Emergency nephrostomy tube exchange is frequent. Cognitive impairment is a key patient-level risk factor for both emergency exchange and reduced tube patency.