Symptomatic Urinary Stone Disease in Pregnancy

Abstract

Background: Symptomatic urinary calculi are rare in pregnancy with an incidence of one per 1500 pregnant women. Calculi may cause ureteric obstruction that can be further complicated by sepsis. This may have a significant morbidity for mother and fetus. Objective: To provide an update on the current investigations and management options for pregnant patients with symptomatic urinary calculi. Discussion: We discuss the different imaging modalities available to investigate the renal tract in pregnant women and propose a management pathway. This topic is particularly pertinent to obstetricians in their roles as coordinators of prenatal care.

Burden of Symptomatic Renal Stones in Pregnancy Managed Till Normal Delivery: A Case Report in Developing Nation

“…The bilateral hydronephrosis of index case presented is not physiologic because there was background history of flanks pain even before the pregnancy. Other promoters of stone formation include UTI and increase in urinary excretion of calcium and uric acid resulting from increased Glomerular Filtration Rate (GFR) and Renal Plasma Flow of Pregnancy [1,8]. However, the effect of the extra solute load is countered by the increased urinary excretion of citrate which is a urolithiasis inhibitor as such the rate of stone formation in pregnant patient is similar to age-matched non pregnant women [9,10].…”

“…An initial diagnosis of left pyelonephritis with differentials of left ureteric calculus and left renal calculus were made. Abdominopelvic ultrasound scan revealed an intrauterine viable gestation of 13 weeks with 5 days old as shown in Figure 1a, there was also dilatation of the pelvicalyceal system involving the proximal part of left ureter and presence of 2 calculi within the left renal pelvis, the larger one measured 1.6cm in size as shown in FigureIntroduction Urinary tract calculi presenting during pregnancy are rare, with recurrent incidence about 1 per 1500 (0.07%) pregnant patients [1]. Cumulative incidence of hospital admission for nephrolithiasis during pregnancy is as low as 1.7 per 1000 deliveries [2].…”

Nephrostomy in pregnancy a district general hospital experience over five years

“…The process of hydroureteronephrosis may start as early as the sixth week of pregnancy and 90% of pregnant women would have some element of hydronephrosis by the 28th week of gestation. [1][2][3] The mechanism of the development of hydro-ureter and hydronephrosis during pregnancy is not very clear; nevertheless, it may be a sequel of a combination pressure on the ureters at the pelvic brim and smooth muscle relaxation pursuant to the hormonal changes associated with pregnancy. Hydro-ureter and hydro-nephrosis of pregnancy is more common on the right side, perhaps because of dextrorotation of the uterus and the sigmoid colon cushioning the ureter on the left.…”

“…Hydro-ureter and hydro-nephrosis of pregnancy is more common on the right side, perhaps because of dextrorotation of the uterus and the sigmoid colon cushioning the ureter on the left. [1,2,4] In majority of pregnancies these changes of hydroureteronephrosis within the upper urinary tract remain asymptomatic and do not emanate in complications. [2] The aforementioned changes have therefore been referred to as physiological changes.…”

“…[1,2,4] In majority of pregnancies these changes of hydroureteronephrosis within the upper urinary tract remain asymptomatic and do not emanate in complications. [2] The aforementioned changes have therefore been referred to as physiological changes. [2] It had been stated that five per-cent to ten per-cent of pregnant women develop flank pain necessitating investigations and referral for urological opinion.…”