Our ultrasonographic experience in the management of symptomatic hydronephrosis during pregnancy

Abstract

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...

Assessment of Incidence of Hydroureteronephrosis among Pregnant Women of a Tertiary Care Hospital

“…In the present study, hydroureteronephrosis was observed in 47.5% of the study subjects on the right side and 30% of the study subjects on the left side while Oyinloye et alin their study reported that hydroureteronephrosis of pregnancy was observed in 93.4% of the study subjects in the right side and 84.4% of the study subjects in the left side [22]. Dell'atti et al in their study reported that hydroureteronephrosis of pregnancy was observed in 61% of the study subjects on the right side and in 39% of the study subjects on the left side which is consistent with the findings of our study [23]. Hydroureteronephrosis is more pronounced on the right side.…”

Comparison of Conservative and Surgical Treatments in Symptomatic Pregnancy Hydronephrosis

“…A renal pelvis AP diameter of >20 mm in pregnant women is considered as progressive hydronephrosis. In some previous studies, surgical treatment was recommended for pregnant women with severe or progressive hydronephrosis [15, 19]. In some other studies, cut-off values were determined for renal pelvis AP diameter in treatment selection and its use as a predictive parameter in treatment selection was emphasized.…”

Maternal hydronephrosis in pregnant women without ureteral stones and characteristics of symptomatic cases who need treatment: A single-center prospective study with 1026 pregnant women

“…And a few weeks after birth completely disappeared (15,18,20). The first-line imaging test to diagnose maternal hydronephrosis is ultrasonography (US) (21,22).…”

“…Because US is a non-invasive and ionizing radiation-free imaging technique (21). In addition, maternal nephrosonography findings during pregnancy were quantitatively and qualitatively documented years ago (15,16).…”

“…Magnetic resonance imaging (MRI) technique may be preferred in these patients (22). But the first step of the imaging method that should be preferred during pregnancy is US (21,23). For detection of maternal renal dilatations, intrarenal calyceal dilatations or anteroposterior renal pelvis diameter (APD) are measured by US (4,25,26).…”