Nephrolithiasis and pregnancy

McAleer, S.; Loughlin, Kevin R.

doi:10.1097/00042307-200403000-00013

Cited by 119 publications

(62 citation statements)

References 34 publications

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“…The use of double-J stent in order to bypass urinary obstruction in pregnant women has been documented in several series [8,9].…”

Section: Introductionmentioning

confidence: 99%

Our ultrasonographic experience in the management of symptomatic hydronephrosis during pregnancy

Dell’Atti

2014

J Ultrasound

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Introduction The aim of the present study was to document the role of ultrasound in the diagnosis and management of symptomatic hydronephrosis during pregnancy. Methods In this study, we reviewed 36 consecutive cases of pregnant women whose pregnancy was complicated by symptomatic hydronephrosis. In all patients, management was initially conservative (analgesics and fluids) after hospitalization. The following criteria were used to indicate double-J stent placement under US guidance rather than a conservative treatment: persistent pain with no improvement after conservative treatment, progressive hydronephrosis ([2 cm dilatation of the renal pelvis) or presence of uterine contractions. Results The mean patient's age was 25 years (17-35) and gestational age at clinical presentation was 24 weeks (13-37). 81 % of cases had a renal pelvis dilatation[2 cm, while in only 19 % of cases there was a hydronephrosis between 1 and 2 cm in diameter; however, calculi were confirmed only in 25 patients. 28 patients required an invasive management with double-J stent insertion under US guidance. The sensitivity and specificity of US in the etiological diagnosis of hydronephrosis during pregnancy was 83 and 91 %, respectively. Conclusion Conservative management with medical therapy and observation should be the first-line treatment approach. In our opinion a rapid ureteral decompression with the insertion of a ureteral double-J stent, under US visualization, is the safest method in the treatment of pregnant women with obstructed renal systems.Keywords Pregnancy Á Hydronephrosis Á Stones Á Ultrasound Á Stent Á Ureteroscopy Riassunto Introduzione Lo scopo del presente studio è stato quello di analizzare il ruolo dell'ecografia nella diagnosi e gestione durante la gravidanza di pazienti affette da idronefrosi sintomatica. Metodi In questo studio abbiamo preso in esame 36 casi di donne in gravidanza complicata dall'insorgenza di un'idronefrosi sintomatica. In tutti i pazienti fu adottato dopo il ricovero in un primo momento un trattamento conservativo (con idratazione e analgesici). I criteri utilizzati per porre indicazione nel posizionamento di uno stent doppio J sotto guida ecografica al posto di un trattamento conservativo sono stati: dolore al fianco persistente senza alcun miglioramento dopo terapia medica, progressivo incremento del quadro idronefrotico (diametro della pelvi renale [2 cm) o comparsa di contrazioni uterine. Risultati L'età media delle pazienti è stata di 25 anni (range 17-35), mentre l'età gestazionale al momento della presentazione del quadro clinico è stata di circa 24 settimane (range 13-37). L'81 % delle pazienti aveva una dilatazione della pelvi renale [2 cm, mentre solo nel 19 % c'è stata un idronefrosi compresa tra 1 e 2 cm di diametro; tuttavia la presenza di calcolosi è stata confermata in sole 25 pazienti. In ventotto pazienti è stata necessaria una gestione invasiva con posizionamento di stent doppio J sotto guida ecografica. La sensibilità e la specificità dell'ecografia nella diagnosi ezio...

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“…The use of double-J stent in order to bypass urinary obstruction in pregnant women has been documented in several series [8,9].…”

Section: Introductionmentioning

confidence: 99%

Our ultrasonographic experience in the management of symptomatic hydronephrosis during pregnancy

Dell’Atti

2014

J Ultrasound

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“…80,81 Ureteroscopy is also the method of choice for treating urethral calculi during pregnancy, with rates of success and of complications that are comparable with those for patients who are not pregnant. 82,83,84 In our opinion, flexible ureteroscopy is gaining ground in Brazil and without doubt, as costs reduce, will soon be disseminated throughout the country. Although it is infrequently indicated nowadays, accounting for around 1% of procedures for removal of calculi in the United States, 85 open surgery still has a role in treatment of urinary calculi.…”

Section: Resultsmentioning

confidence: 98%

O que há de novo no diagnóstico e tratamento da litíase urinária?

Mazzucchi¹,

Srougi²

2009

Rev. Assoc. Med. Bras.

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Objective. To review developments in the diagnosis and treatment of urinary lithiasis. MethOds. A review of the most important articles on the subject published in Medline indexed periodicals between 1979 and 2009. Results. Stones occur with greater frequency among people with BMI > 30. Computerized tomography without contrast provides the correct diagnosis in up to 98% of cases. Alpha-adrenergic blockers increase elimination of ureteral calculi smaller than 8 mm by 29%. The proportion of patients free from calculi after ESWL varies from 35% to 91%, depending on size and location. In between 60% and 100% of cases, renal calculi larger than 2 cm are eliminated with PCNL. Calculi of the distal ureter are successfully treated in up to 94% of cases using semi-rigid ureteroscopy, compared to 74% using ESWL. For calculi of the upper ureter success rates are around 77% and 91% for ureteroscopy and 41% and 82% for ESWL. cOnclusiOn. The association between urinary lithiasis and Diabetes mellitus, is well-established. Computerized tomography without contrast is currently the gold standard for diagnosis of urinary lithiasis. In Brazil, ESWL is the method of choice for treating renal calculi smaller than 2 cm and with tomographic density < 1000 HU, except those of the lower pole, where the ideal limit for treatment is 1 cm. Percutaneous nephrolithotripsy is the best method of treating renal calculi larger than 2 cm and semi-rigid ureteroscopy is the best treatment for calculi of the distal ureter. Flexible ureteroscopy is an option for calculi of the upper ureter and renal calculi smaller than 1.5 cm that do not respond to ESWL or where PCNL is contraindicated.

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“…An ongoing clinical trial will shed more light on this very important topic. 9,[41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] Ultrasound First (And Always? ): Central Venous Access…”

Section: Lynn a Fordham MDmentioning

confidence: 99%