Urolithiasis in pregnancy. I: pathophysiology, fetal considerations and diagnosis

Biyani, Chandra Shekhar; Joyce, Adrian

doi:10.1046/j.1464-410x.2002.02772.x

Cited by 89 publications

(69 citation statements)

References 52 publications

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“…Approximately 1 out of 500 pregnancies are complicated by the presence of urinary calculi and the incidence of ureteral colic is the same as in non-pregnant women in reproductive age [1,2]. Ureteral stones in pregnant women become clinically manifested during the second and third trimesters of pregnancy in 80-90 % of patients [3].…”

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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Section: Introductionmentioning

confidence: 99%

Our ultrasonographic experience in the management of symptomatic hydronephrosis during pregnancy

Dell’Atti

2014

J Ultrasound

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“…Within this group, 80–90% of pregnant women are in the 2nd or 3rd trimester of their pregnancy. Multiparous women are also more commonly affected [4,5,6,7]. …”

Section: Introductionmentioning

confidence: 99%

Outcomes of Ureteroscopy for Stone Disease in Pregnancy: Results from a Systematic Review of the Literature

et al. 2012

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Introduction: Our aim was to evaluate the clinical efficacy and safety of ureteroscopy as a primary treatment for pregnant women with symptomatic ureteric stones who have failed conservative management. Materials and Methods: A systematic review of the literature from January 1990 to June 2011 was performed, including all English language articles. Outcome measures were clinical efficacy, in terms of stone clearance and need for additional procedures, and safety in terms of complications. Results: A total of 239 abstracts were screened and 15 studies were identified reporting on 116 procedures. The surgical methods of stone management employed were stone extraction with basket only (n = 55, 47%), laser fragmentation (n = 27, 23%; holmium, n = 20, pulse dye, n = 7), impact lithotripsy (n = 21, 18%), ureteroscopic lithotripsy (n = 6, 5%) and a combination of methods (n = 6, 5%). A post-operative stent was inserted in 64 of 116 procedures (55%). Complete stone clearance was seen in 100 of the 116 procedures (86%). There were 2 major complications (1 ureteral perforation and 1 case of premature uterine contraction) and 7 minor complications (5 urinary tract infections and 2 cases of post-operative pain). Conclusion: This review suggests that stone clearance using ureteroscopy is a relatively safe option in pregnancy with a high success rate.

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“…Real-time ultrasound is now being used as a first-line imaging technique for urolithiasis during pregnancy, as it does not involve risks of radiation exposure like teratogenicity, mutagenicity and carcinogenicity to the foetus [38,39] . It is also the imaging tool of choice for detecting and locating renal stones in children [39] .…”

Section: Imagingmentioning

confidence: 99%

“…It found applicability in visualising pathological changes caused by stones in the urinary tract of paediatric and pregnant patients owing to its superior soft tissue contrast and for it does not carries risk associated with ionizing radiations [38,50] , until high doses of paramagnetic contrast were found to be teratogenic [44] . But it has proved to be a safer alternative with no mandatory requirement for administration of contrast media [38] .…”

Section: Imagingmentioning

confidence: 99%

Urolithiasis: An Update on Diagnostic Modalities and Treatment Protocols

Bawari¹,

Sah²,

Tewari³

2017

Journal of Pharmaceutical Sciences

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Sweta, et al.: Diagnosis and Treatment of UrolithiasisUrolithiasis or urinary stone disease is a ubiquitous affliction that spares no geographical region or demographic. Plenty of research is being carried out in quest for mitigating this disease condition. However, any detailed information that could impart knowledge on all the major aspects of the subject in an unfractionated form is still deficient. This review is an attempt to revive the existing knowledge on urolithiasis, basically focused on its diagnosis and treatment and to provide a comprehensive data and up-to-date information on the subject matter. This article also focuses on synthetic drugs and formulations available for the treatment of urolithiasis in the global market and provides a section pertaining to risk factors and dietary preventive measures for urolithiasis.

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Urolithiasis in pregnancy. I: pathophysiology, fetal considerations and diagnosis

Cited by 89 publications

References 52 publications

Our ultrasonographic experience in the management of symptomatic hydronephrosis during pregnancy

Our ultrasonographic experience in the management of symptomatic hydronephrosis during pregnancy

Outcomes of Ureteroscopy for Stone Disease in Pregnancy: Results from a Systematic Review of the Literature

Urolithiasis: An Update on Diagnostic Modalities and Treatment Protocols

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