Detection of distal ureteral stones in pregnancy using transvaginal ultrasound

Bold, Michael S.; Boyum, James H.; Potretzke, Aaron M.; Rose, Carl H.; Atwell, Thomas D.; Sviggum, Erik B; Goss, Brian C.; Brown, Douglas L.

doi:10.1007/s40477-020-00504-4

Cited by 12 publications

(6 citation statements)

References 20 publications

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“…This index typically rises in cases of acute ureteric obstruction. A value exceeding 0.70 is deemed clinically significant [11][12][13].…”

Section: On Ultrasoundmentioning

confidence: 99%

Navigating the Complexities of Symptomatic Hydronephrosis in Pregnancy

Khalabazyane,

David,

Rashid

et al. 2024

Cureus

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The management of symptomatic hydronephrosis presents substantial challenges due to the absence of consensus within clinical guidelines concerning pain management, diagnostic approaches, therapeutic interventions, and follow-up protocols.This literature review focuses on complexities involving diagnostic challenges that arise from the difficulty in distinguishing physiological from pathological obstruction and treatment complexities that involve deciding on the most appropriate pain management medications and safe interventions while minimizing risks to both the mother and foetus.To address these challenges, a comprehensive search of electronic databases, including PubMed, Embase, and Google Scholar, was conducted for the terms "hydronephrosis", "hydronephrosis in pregnancy", "ionising radiation in pregnancy", and "safe analgesia in pregnancy". Moreover, Mendeley software was used to collect and organize the references.Diagnostic complexities involve selecting the appropriate imaging modality that balances accurate diagnosis with minimal radiation to the foetus. Ultrasound remains the first-line option. However, it has limitations in delineating the underlying aetiology. MRI avoids ionizing radiation but has restricted utility due to foetal movement artifacts. CT provides the highest diagnostic accuracy but raises foetal radiation exposure concerns, though ultra-low dose protocols (<1 mGy) are deemed acceptable by most guidelines.Management includes either a conservative approach, which is a safe option in the majority of cases, or intervention with a percutaneous nephrostomy or ureteric stent insertion, both with comparable symptom control. However, there is no consensus on the optimal frequency for drain changes to prevent rapid encrustation. Definitive procedures like ureteroscopy and percutaneous nephrolithotomies remain controversial. Most guidelines suggest limiting these interventions to specialist centres during the second trimester if required.

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“…This index typically rises in cases of acute ureteric obstruction. A value exceeding 0.70 is deemed clinically significant [11][12][13].…”

Section: On Ultrasoundmentioning

confidence: 99%

Navigating the Complexities of Symptomatic Hydronephrosis in Pregnancy

Khalabazyane,

David,

Rashid

et al. 2024

Cureus

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“…[21] A retrospective study supported the utility of TVUS in evaluating distal stones, with 94% of distal stones detected with TVUS compared with the 29% detected transabdominally. [22] In cases of uncertainty, adjunct measurements, such as ureteral jets, improve US imaging characteristics. Physiologically, ureteral jets are seen as periodic effluxes of urine from the distal ureter to the bladder, which are detected by color Doppler studies of the base of the bladder and trigone.…”

Section: Ultrasoundmentioning

confidence: 99%

Management of urolithiasis in pregnancy

et al. 2023

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Urolithiasis is the most common cause of nonobstetric abdominal pain, resulting in 1.7 admissions per 1000 deliveries. Urolithiasis most commonly occurs in the second and third trimesters, with an incidence between 1:125 and 1:2000. Acute urinary system obstructions are challenging to manage in obstetric patients because they contribute to physiological and anatomical changes that result in pathological outcomes. The restricted use of computed tomography in diagnosing and managing urolithiasis is particularly challenging. In addition, a prompt diagnosis is required because the presence of renal calculi during pregnancy increases the risk of fulminating sepsis and preterm delivery. Affected pregnancies are conservatively managed; however, 1 in 4 requires surgical intervention. Indications for surgical interventions are complex and range from nephrostomy insertion to empirical stent placement or ureteroscopy. Therefore, a multidisciplinary approach is required to optimize patient care.The diagnosis and management of urolithiasis in pregnancy are complex. We reviewed the role, safety, advantages and disadvantages of diagnostic tests and treatment used to manage acute urinary obstructions in pregnancy.

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“…However, the finding of a dilated infra-iliac ureter should suggest the presence of a low ureteral stone, excluding gestational hydronephrosis [ 75 ]. Transvaginal US has been shown to be useful in evaluating the distal ureter, as well as the differentiation between obstruction and physiologic hydronephrosis, when abdominal US is inconclusive; however, the lack of availability and expertise may limit its employment [ 76 ].…”

Section: Urogenital Tract Diseasesmentioning

confidence: 99%

Imaging of Acute Abdominopelvic Pain in Pregnancy and Puerperium—Part II: Non-Obstetric Complications

Masselli,

Bonito,

Gigli

et al. 2023

Diagnostics

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Emergency imaging in pregnancy and puerperium poses unique challenges both for clinicians and radiologists, requiring timely and accurate diagnosis. Delay in treatment may result in poor outcomes for both the patient and the foetus. Pregnant and puerperal patients may present in the emergency setting with acute abdominopelvic pain for various complications that can be broadly classified into obstetric and non-obstetric related diseases. Ultrasonography (US) is the primary diagnostic imaging test; however, it may be limited due to the patient’s body habitus and the overlapping of bowel loops. Computed tomography (CT) carries exposure to ionising radiation to the foetus, but may be necessary in selected cases. Magnetic resonance imaging (MRI) is a valuable complement to US in the determination of the etiology of acute abdominal pain and can be used in most settings, allowing for the identification of a broad spectrum of pathologies with a limited protocol of sequences. In this second section, we review the common non-obstetric causes for acute abdominopelvic pain in pregnancy and post partum, offering a practical approach for diagnosis and pointing out the role of imaging methods (US, MRI, CT) with the respective imaging findings.

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Detection of distal ureteral stones in pregnancy using transvaginal ultrasound

Cited by 12 publications

References 20 publications

Navigating the Complexities of Symptomatic Hydronephrosis in Pregnancy

Navigating the Complexities of Symptomatic Hydronephrosis in Pregnancy

Management of urolithiasis in pregnancy

Imaging of Acute Abdominopelvic Pain in Pregnancy and Puerperium—Part II: Non-Obstetric Complications

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