Experience with the Diagnosis and Management of Symptomatic Ureteric Stones During Pregnancy

CUA Guideline: Management of ureteral calculi

“…101 In a recent study, conservative management was successful in 67% of patients, who had symptomatic obstructing ureteral stones with an average stone size of 8.8 mm. 102 Immediate causes for intervention are the same as those in non-pregnant situations (signs of sepsis, renal failure, and unrelenting pain, etc. ), but also include induction of premature labour (contractions, fetal distress) in the pregnant patient.…”

“…104 In fact, if ultrasound imaging is non-diagnostic and low-dose CT or MRI is unavailable, URS can also be used for both diagnostic and therapeutic purposes. 102 A number of studies have demonstrated that URS is a viable technique to treat stones in pregnancy. 102,105,106 Postoperative stenting following URS in this situation is recommended in an attempt to reduce postoperative complications.…”

“…102 A number of studies have demonstrated that URS is a viable technique to treat stones in pregnancy. 102,105,106 Postoperative stenting following URS in this situation is recommended in an attempt to reduce postoperative complications. 102 Ideally ureteroscopic treatment should be performed in the second trimester, as teratogenic effects and risks of anaesthesia are higher in the first trimester.…”

“…102,105,106 Postoperative stenting following URS in this situation is recommended in an attempt to reduce postoperative complications. 102 Ideally ureteroscopic treatment should be performed in the second trimester, as teratogenic effects and risks of anaesthesia are higher in the first trimester. 103 With regards to intraoperative imaging, if URS or ureteral stent insertion is undertaken, then a lead apron or shield should be put between the x-ray fluoroscopy source and the fetus to shield it from radiation.…”

Response to the letter by Sharma et al.: Intracutaneous sterile water injection versus oral paracetamol for renal colic during pregnancy: a randomized controlled trial. Int Urol Nephrol 2013; 45:321–325, DOI 10.1007/s11255-013-0405-3

“…However, when conservative approach fails, URSL may be a good alternative approach for definitive treatment [1].…”