Introduction: The occurrence of urolithiasis in pregnancy represents a challenge in both diagnosis and treatment of this condition, because it presents risks not only to the mother but also to the fetus. Surgical treatment may be indicated for patients with infection, persistent pain, and obstruction of a solitary kidney. We present our experience on the management of pregnant patients with ureteral calculi and a review of the literature. Materials and Methods: The charts of 19 pregnant patients with obstructive ureteral calculi were retrospectively reviewed. Gestational age ranged from 13 to 33 weeks. In all patients, ureteral stone was diagnosed on abdominal ultrasound. In regard to localization, 15 calculi were in the distal ureter, 3 in the proximal ureter, and 1 in the interior of an ureterocele. Calculi size ranged from 6 to 10 mm (mean, 8 mm). The following criteria were used to indicate ureteroscopy: persistent pain with no improvement after clinical treatment, increase in renal dilation, or presence of uterine contractions. Nine patients (47.3%) were submitted to ureteroscopy. All calculi (100%) were removed with a stone basket extractor under continuous endoscopic vision. None of the calculi demanded the use of a lithotriptor. Results: Nine patients (47.3%) treated with clinical measurements presented no obstetric complications and spontaneous elimination of the calculi. Nine patients (47.3%) submitted to ureteroscopy had no surgical complications. There was remission of pain in all cases after ureteroscopy and ureteral catheter placement. Conclusion: The diagnosis and treatment of ureteral lithiasis in pregnant women present potential risks for the fetus and the mother. Conservative management is the first option, but ureteroscopy may be performed with safety and high success rates.

OBJECTIVE:Urinary lithiasis is a common disease. The aim of the present study is to assess the knowledge regarding the diagnosis, treatment and recommendations given to patients with ureteral colic by professionals of an academic hospital.MATERIALS AND METHODS:Sixty-five physicians were interviewed about previous experience with guidelines regarding ureteral colic and how they manage patients with ureteral colic in regards to diagnosis, treatment and the information provided to the patients.RESULTS:Thirty-six percent of the interviewed physicians were surgeons, and 64% were clinicians. Forty-one percent of the physicians reported experience with ureterolithiasis guidelines. Seventy-two percent indicated that they use noncontrast CT scans for the diagnosis of lithiasis. All of the respondents prescribe hydration, primarily for the improvement of stone elimination (39.3%). The average number of drugs used was 3.5. The combination of nonsteroidal anti-inflammatory drugs and opioids was reported by 54% of the physicians (i.e., 59% of surgeons and 25.6% of clinicians used this combination of drugs) (p = 0.014). Only 21.3% prescribe alpha blockers.CONCLUSION:Reported experience with guidelines had little impact on several habitual practices. For example, only 21.3% of the respondents indicated that they prescribed alpha blockers; however, alpha blockers may increase stone elimination by up to 54%. Furthermore, although a meta-analysis demonstrated that hydration had no effect on the transit time of the stone or on the pain, the majority of the physicians reported that they prescribed more than 500 ml of fluid. Dipyrone, hyoscine, nonsteroidal anti-inflammatory drugs, and opioids were identified as the most frequently prescribed drug combination. The information regarding the time for the passage of urinary stones was inconsistent. The development of continuing education programs regarding ureteral colic in the emergency room is necessary.

RESUMO: As malformações vasculares representam uma das principais causa de hemorragia digestiva baixa em doentes idosos.O acometimento de indivíduos com menos de trinta anos é evento raramente descrito. Objetivo: O objetivo do presente relato é apresentar um caso de angiodisplasia, localizada na região cecal, em doente na terceira década de vida, diagnosticada por meio de arteriografia pré-operatória e confirmada pelo estudo anátomo-patológico. Relato do caso: Homem, 29 anos, com queixa de anemia crônica de origem obscura há vários anos e refratária ao tratamento clínico e transfusional. Com o objetivo de investigar possível origem digestiva foi submetido à arteriografia seletiva abdominal que demonstrou a presença de malformação vascular, localizada na região cecal. Realizou-se colectomia direita onde foi possível confirmar a localização da enfermidade pela arteriografia pós-operatória do espécime extirpado e o diagnóstico definitivo de angiodisplasia pelo estudo anátomo-patológico. Após a intervenção cirúrgica apresentou evolução favorável, estando atualmente no 5º mês pós-operatório sem apresentar sinais de recidiva da anemia. Conclusão: Não obstante à raridade, a possibilidade de angiodisplasia deverá ser sempre considerada na investigação da anemia de causa obscura em doentes jovens.Descritores: Angiodisplasia. Malformações arteriovenosas. Doenças do Ceco. Cirurgia Colorretal. Cólon.