Management of ureteric stone in pregnancy: a review

Abstract

Background Urolithiasis in pregnancy is a major health concern and is one of the most common causes for non-obstetrical abdominal pain and subsequent hospital admission during pregnancy. The incidence of urinary calculi during pregnancy varies in the range of 1/200 to 1/2000. Acute ureteric colic in pregnancy is associated with significant potential risks to both mother and fetus. Significant anatomic and functional changes occur in pregnancy which not only lead to stone formation but also create diagnostic dilemma. The diagnosis of ureteric calculi can be incorrect in about 28% of pregnant patients. Main body Management of ureteric stone during pregnancy is remaining to be a challenge for the treating urologist. Because of the inability to use good imaging options for the diagnosis confirmation and more invasive approach for the treatment, management continues to be difficult. The main threats are preterm labor with delivery and premature rupture of membranes. Other pregnancy complications are obstructive uropathy, gestational diabetes mellitus, recurrent abortions and pre-eclampsia. Management of diagnosed ureteric stone is unique in the pregnant population and requires multi-disciplinary care. It should be individualized for each patient and moves preferably from conservative to invasive approaches sequentially. With continued advancements in endourological techniques, few definitive treatment options are also available for such patients. Conclusion There are several lacunae related with the diagnostic imaging, medical expulsive therapy, reliability of ureteral stent/percutaneous nephrostomy insertions and safety of ureteroscopy during pregnancy. Herein, we review the management of ureteric stone during pregnancy, the various diagnostic modalities and treatment options with their advantages and disadvantages. We also proposed our management algorithm to deal with such clinical scenario in this particular population.

Live donor nephrectomy side: Is it implicated in urologic complications among lady donors during their post-donation pregnancies?

“…In our study, right and left donor nephrectomy group ladies were comparable in terms of urologic complications during postdonation pregnancy as well as blood pressure, kidney function, urine analysis and ultrasound ndings at last follow up contrary to our expectation that donors with a solitary right kidney would be more liable to urologic complications of pregnancy and subsequent impact on kidney function. Nevertheless, our results could be supported by extrapolation from studies of the general population that did not show an increased prevalence of urinary tract infection [12] or stone kidney disease [13][14][15] during pregnancy despite the known anatomic and physiologic effects of pregnancy on the urinary system. In addition, donors included in our study didn't have a periodic follow up renal ultrasound throughout pregnancy and we, therefore, are not con dent whether they experienced hydronephrosis and whether those with a solitary right (compared to left) kidney had a signi cantly higher prevalence and/or degree of hydronephrosis during their post-donation pregnancy.…”

Management of urolithiasis in pregnancy: A systematic review and meta-analysis

“…34 Urolithiasis during pregnancy is one of the leading causes of abdominal pain and subsequent hospital admission during the pregnancy. 1 From the etiological point of view, anatomical and physiological changes during the pregnancy may impact the potential stone formation and make pregnant women more susceptible to kidney stones. 53,54 Yet, studies could not detect a significant incidence difference between pregnant and nongravid women.…”

“…51 During the first trimester and in the case of large stone burden, sepsis, or pyonephrosis, PCN is also a helpful intervention, which can be performed under local anesthesia with US guidance. 1,29 Its efficacy is near 100%.…”

“…The incidence of urinary stones during pregnancy varies from 1/200 to 1/2000, not different from non-pregnant women. 1,2 Urolithiasis is more common in the second or third trimester of pregnancy and is more common in multiparous women. 3 Predisposing factors for stone formation in pregnancy include dilatation of the urinary tract due to ureteral obstruction by the uterus, the relaxing effect of progesterone smooth muscle, and infection.…”

Management of Kidney Stone Disease in Pregnancy: A Practical and Evidence-Based Approach

“…MRI can also serve to visualise other causes for the abdominal pain such as appendicitis. Several protocols have been described such as thin-slice, fast spin echo (FSE) for detection of small stones [31]. An alternative is the half-life Fourier singe-shot turbo spin-echo (HASTE) protocol, which can be completed in less than 15 min [32].…”