INTRODUCTION:: There is little data on medium- and long-term complications after placement of percutaneous nephrostomy tubes (PCNs) placed for malignant urinary obstruction due to gynecologic cancers and no evidence-based recommendations to guide time to PCN exchange. We sought to define the frequency and time distribution of these complications. METHODS:: Patients with malignant urinary obstruction due to a gynecologic malignancy that underwent placement and at least one exchange of a PCN between 2011 and 2013 were reviewed. Exchanges were classified as routine (not due to a complication), or due to one of three complication types: mechanical (tube dislodgement), obstruction, or infection (i.e. pyelonephritis). RESULTS:: Thirty-three patients with 59 exchange encounters were included. Twenty-six (79%) patients had cervical cancer. Twenty-one (36%) of exchange encounters were routine, occurring at a median of 96 days (interquartile range: 91-101 days), while 15 (25%) were due to tube obstruction, occurring at a median of 48 days (IQR: 15-59 days). Seventeen (29%) were due to infection, occurring at a median of 66 days (IQR: 38-93 days), and 6 (10%) were due to mechanical dislodgement, occurring at a median of 66 days (IQR: 52-82 days). CONCLUSION:: Medium- and long-term complications were frequent after PCN placement for obstruction due to gynecologic malignancies, as nearly two-thirds of exchanges were due to a complication. Additionally, the median time for each complication type is nearly one month before the currently recommended scheduled routine exchange time. Further work can quantify the excess cost due to these complications and determine the most cost-effective time for routine scheduled exchanges.