Pearls and Pitfalls in Sonographic Imaging of Symptomatic Urolithiasis in Pregnancy

Vallurupalli, Kalyani; Atwell, Thomas D.; Krambeck, Amy E.; Traynor, Kyle D.; Brown, Douglas L.; LeRoy, Andrew J.

doi:10.1097/ruq.0b013e31827d2aad

Cited by 10 publications

(4 citation statements)

References 13 publications

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“…The presence of hydroureter distal to the iliac vessels indicates obstruction as compared to physiological hydronephrosis of pregnancy [38]. Severe left-side hydroureteronephrosis also indicates pathological cause of obstruction because commonly in pregnancy only mild to moderate dilation occurs on left-sided pelvicalyceal system [39]. Doppler-assisted measurement of the resistive index (RI) has been described to distinguish physiological hydronephrosis from pathologic obstruction.…”

Section: Ultrasonography (Usg)mentioning

confidence: 99%

Management of ureteric stone in pregnancy: a review

et al. 2020

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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.

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Section: Ultrasonography (Usg)mentioning

confidence: 99%

Management of ureteric stone in pregnancy: a review

et al. 2020

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“…In attempts to improve the diagnostic accuracy of ultrasonography a number of adjunct measurements have been utilized including urinary jets, endovaginal ultrasound, and resistive indices (RI). The location of hydroureteronephrosis can be suggestive of acute obstruction; for instance, hydroureter distal to the iliac vessels or severe left hydroureteronephrosis can be indicative of pathologic obstruction [30] . The visualization of urinary jets can suggest the absence of obstructing calculi, however, 13% of pregnant patients without stones will have an absence of their urinary jet [31] .…”

Section: Pregnancymentioning

confidence: 99%

“…The visualization of urinary jets can suggest the absence of obstructing calculi, however, 13% of pregnant patients without stones will have an absence of their urinary jet [31] . The use of endovaginal ultrasound can assist in the detection of distal ureteric calculi and urinary jets, but is contraindicated in the presence of ruptured or prolapsed membranes [30] . Doppler ultrasound with the measurement of RI has also been utilized to distinguish physiologic hydronephrosis from pathologic obstruction.…”

Section: Pregnancymentioning

confidence: 99%

Stones in pregnancy and pediatrics

Bjazevic

Razvi

2018

Asian Journal of Urology

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Urinary stone disease is a highly prevalent condition affecting approximately 10% of the population, and has increased in incidence significantly over the past 20 years. Along with this, the rate of stone disease among women and children is also on the rise. The management of stone disease in specific populations, such as in children and during pregnancy can present unique challenges to the urologist. In both populations, a multi-disciplinary approach is strongly recommended given the complexities of the patients. Prompt and accurate diagnosis requires a high degree of suspicion and judicious use of diagnostic imaging given the higher risks of radiation exposure. In general, management proceeds from conservative to more invasive approaches and must be individualized to the patient with careful consideration of the potential adverse effects. However, innovations in endourologic equipment and techniques have allowed for the wider application of surgical stone treatment in these patients, and significant advancement in the field. This review covers the history and current advances in the diagnosis and management of stone disease in pregnant and pediatric populations. It is paramount for the urologist to understand the complexities of properly managing stones in these patients in order to maximize treatment efficacy, while minimizing complications and morbidity.

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“…A few investigators have evaluated the ability to visualize ureteral calculi using transvaginal ultrasound (TVUS) revealing improved stone identification compared to transabdominal ultrasound (TAUS) alone [ 9 , 10 ]. However, the reliability of a negative TVUS of the distal ureters in this setting has remained unclear [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Detection of distal ureteral stones in pregnancy using transvaginal ultrasound

et al. 2020

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Aims To determine the performance of transvaginal ultrasound for the visualization of distal ureteral stones in pregnant patients with renal colic and to evaluate the diagnostic value of secondary findings suggestive of obstructing ureteral stone disease. Methods We retrospectively identified 129 pregnant patients with a total of 142 encounters with both abdominal and transvaginal ultrasound. Ultrasound images for each patient were reviewed recording the presence of stone with location, hydronephrosis, resistive indices (RI), and status of the ureteral jets. Patients were subcategorized into two groups based on the visualization of distal ureteral stone. Results The transvaginal technique identified 94% (N = 16/17) of sonographically detected stones in the distal ureter/urethra, while the transabdominal technique identified 29% (N = 5/17). The combined imaging for initial assessment of renal colic in pregnancy demonstrated a sensitivity of 89%, specificity 100%, and negative predictive value (NPV) of 98%. The frequency of hydronephrosis was statistically greater in the visualized stone group (94% vs 51%). Mean RI was identical in both groups however the delta RI was significantly elevated in those patients with distal ureteral stones with a mean delta RI value of 0.05. The rate of absence of ureteral jets was not statistically significant. Conclusion The present data would suggest a utility of transvaginal ultrasound for the evaluation of the pregnant patient with 94% of distal stones being detected transvaginal versus 29% transabdominally. Additionally, there was significantly increased hydronephrosis and elevated RIs in patients with distal ureteral stones.

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Pearls and Pitfalls in Sonographic Imaging of Symptomatic Urolithiasis in Pregnancy

Cited by 10 publications

References 13 publications

Management of ureteric stone in pregnancy: a review

Management of ureteric stone in pregnancy: a review

Stones in pregnancy and pediatrics

Detection of distal ureteral stones in pregnancy using transvaginal ultrasound

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