Management of symptomatic ureteral calculi during pregnancy: Experience of 23 cases

Abstract

Purpose:To present our experience in the management of symptomatic ureteral calculi during pregnancy.Materials and Methods:Twenty-three pregnant women, aged between 19 and 28 years presented to the obstetric and urology departments with renal colic (17 cases, 73.9%) and fever and renal pain (6 cases, 26.1%); suggesting ureteric stones. The diagnosis was established by ultrasonography (abdominal and transvaginal). Outpatient follow-up consisted of clinical assessment and abdominal ultrasonography. Follow-up by X-ray of the kidneys, ureter, and bladder (KUB), or intravenous urography (IVU) was done in the postpartum period.Results:Double J (DJ) stent was inserted in six women (26%) with persistent fever followed by extracorporeal shock wave lithotripsy (ESWL) one month post-partum. Ureteroscopic procedure and pneumatic lithotripsy were performed for 17 women (distal ureteric stone in 10, middle ureter in 5, and upper ureteric stone in 2). Stone-free rate was 100%. No urologic, anesthetic, or obstetric complications were encountered.Conclusions:Ureteroscopy, pneumatic lithotripsy, and DJ insertion could be a definitive and safe option for the treatment of obstructive ureteric stones during pregnancy.

Application of Ureteroscope in Emergency Treatment with Persistent Renal Colic Patients during Pregnancy

“…Persistent renal colic during pregnancy is a true urological emergency that can become life-threatening sepsis and have associated complications for both the mother and fetus [ 4 ]. Thorough urological, gynecological and general surgical evaluations are needed to exclude other surgical emergencies such as acute appendicitis and a twisted ovarian cyst [ 11 ].…”

“…Existing research shows that maternal kidney stones are significantly associated with several pregnancy complications, including recurrent abortions, hypertensive disorders, gestational diabetes, and cesarean deliveries [ 12 ]. Although ordinary X-ray, IVU and CTU are convenient and conclusive methods of diagnosis in non-pregnant urologic patients, they are not used routinely in symptomatic pregnant women because ionizing radiation is potentially teratogenic and its effects have not been well defined [ 4 , 13 ]. Abdominal ultrasonography was the preferred and most decisive evaluation method for renal colic during pregnancy in many reports and in our series.…”

“…With the high frequency of urolithiasis and a higher likelihood of women developing kidney stones in pregnancy, the diagnosis and treatment of urolithiasis during pregnancy are very frequent [ 1 ]. The incidence of urinary calculi during pregnancy is approximately 0.026–0.531% and may be associated with 40% of preterm births [ 2 , 3 , 4 ]. Ureteroscopy is often considered the first definitive treatment of obstructive ureteral calculi during all trimesters of pregnancy [ 3 ], but for persistent renal colic patients without ultrasound-detected ureteral calculi, it still remains a difficult condition concerning both diagnosis and treatment.…”

Stone disease in pregnancy: imaging-guided therapy

“…Transvaginal US can be helpful to evaluate the distal ureter and distinguish obstruction from physiological hydronephrosis of pregnancy [ 27 ], as demonstrated by Abdel-Kader et al in their study including 23 pregnant women with symptoms suggestive of ureteral calculi [ 28 ].…”

Editorial Comment from Dr Safwat to Risk of urinary stones among women with pelvic organ prolapse: A national population‐based cohort study

“…The age at peak incidence of renal stones in women in Western countries tends to range from 40 to 49 years, whereas in Eastern counties it tends to range between ages 50 and 59 years . In contrast, the risk of stone formation in pregnant women can be affected by the degree of urinary tract dilation as a result of the effect of progesterone, obstruction by the gravid uterus and infection …”