A comparison of adverse pregnancy events between ureteral stents and percutaneous nephrostomy tubes in the treatment of nephrolithiasis during pregnancy: A propensity score-matched analysis of a large multi-institutional research network

Mason, Matthew M.; Nackeeran, Sirpi; Lokeshwar, Soum D.; Mason, Marisa R. Carino; Kohn, Taylor P.; Shah, Hemendra N.; Ramasamy, Ranjith

doi:10.1007/s00345-022-04111-2

Cited by 12 publications

(4 citation statements)

References 22 publications

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“…Moreover, the time interval between the onset of urinary symptoms and hospital admission for further investigations was higher for patients with urosepsis compared to patients with uncomplicated UTIs. All these are known risk factors for developing UTIs in pregnancy [6,51], and we hypothesize that the longer timeframe until admission to the urology department in the case of patients with urosepsis constitutes an important aggravating factor.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy Outcomes in Patients with Urosepsis and Uncomplicated Urinary Tract Infections—A Retrospective Study

Radu,

Vicoveanu,

Cărăuleanu

et al. 2023

Medicina

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Background and Objectives: Urinary tract infections (UTIs) are an important cause of perinatal and maternal morbidity and mortality. The aim of this study was to describe and compare the main pregnancy outcomes among pregnant patients with complicated and uncomplicated UTIs; Materials and Methods: This retrospective study included 183 pregnant patients who were evaluated for uncomplicated UTIs and urosepsis in the Urology Department of ‘C.I. Parhon’ University Hospital, and who were followed up at a tertiary maternity hospital—‘Cuza-voda’ from Romania between January 2014 and October 2023. The control group (183 patients) was randomly selected from the patient’s cohort who gave birth in the same time frame at the maternity hospital without urinary pathology. Clinical and paraclinical data were examined. Descriptive statistics and a conditional logistic regression model were used to analyze our data. Results: Our results indicated that patients with urosepsis had increased risk of premature rupture of membranes (aOR: 5.59, 95%CI: 2.02–15.40, p < 0.001) and preterm birth (aOR: 2.47, 95%CI: 1.15–5.33, p = 0.02). We could not demonstrate a statistically significant association between intrauterine growth restriction and pre-eclampsia with the studied urological pathologies. Conclusions: Careful UTI screening during pregnancy is needed for preventing maternal–fetal complications.

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Section: Discussionmentioning

confidence: 99%

Pregnancy Outcomes in Patients with Urosepsis and Uncomplicated Urinary Tract Infections—A Retrospective Study

Radu,

Vicoveanu,

Cărăuleanu

et al. 2023

Medicina

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“…For instance, ureteral stents placed during pregnancy are often placed under general or regional anesthesia and have up to 16% rate of postprocedural complications such as stent migration, encrustation, intolerance, preterm labor, and early induction 18 . In contrast, nephrostomy tubes can be placed via ultrasound guidance with minimal anesthesia and have recently been shown to confer no increased risk of premature labor or delivery, premature rupture of membranes, or intrauterine infection compared to ureteral stent placement for nephrolithiasis during pregnancy, when placed up to 6 months before delivery 19 . These procedural factors, coupled with more conservative initial management strategies among pregnant women, may also contribute to delays in decompression, even once the diagnosis has been made.…”

Section: Discussionmentioning

confidence: 99%

Differences in management of pregnant women with obstructing infected ureteral stones: A population‐based analysis

Wang

Haas

et al. 2022

Int J of Urology

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Objectives Obstructing ureteral stones complicated by urinary tract infection are urologic emergencies that require prompt decompression. We explore the association of pregnancy with rates of and delays in decompression in a cohort of women of reproductive age. Methods Using the National Inpatient Sample from 2010 to 2015, a cross‐sectional, descriptive analysis of women of reproductive age (15 to 44 years old) diagnosed with obstructing ureteral stones and urinary tract infection was performed and stratified by pregnancy status. Survey‐weighted regression models were used to assess the association of pregnancy on decompression, delays in decompression, and hospital length of stay. Additional exploratory analyses on the association of timing and type of decompression with maternal‐fetal outcomes were performed. Results A weighted total of 38 783 hospitalizations were identified, with 6.1% of admissions occurring in pregnant women. On multivariable regression, pregnant women with obstructing ureteral stones and urinary tract infection were 38% less likely of undergoing decompression (adjusted OR: 0.62; p < 0.001) compared with nonpregnant women. Among those decompressed, pregnant women had greater odds of delayed decompression (adjusted OR: 2.28; p < 0.001) and longer length of stay (adjusted IRR: 1.11; p = 0.007). Delayed decompression among pregnant women was associated with increased rates of C‐section, early or threatened labor, fetal distress, and umbilical cord complications. Conclusions Overall, pregnant women had reduced odds of decompression, as well as increased odds of delayed decompression, when compared with nonpregnant women of reproductive age. Delays in decompression among pregnant women were also associated with increased maternal and fetal complications.

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“…However, ureteric stenting in pregnancy is associated with a lower incidence of urinary tract infection, hospitalization duration, emergency department visits, and frequency of exchange procedures. [40] Ureteric stent insertion can be performed using a retrograde approach via cystoscopy, or an antegrade approach after percutaneous renal puncture, with the location of the stent confirmed using US. Performing this procedure under sedation or local anesthesia in some instances is preferable in the first trimester, because general anesthesia increases the risk of miscarriage.…”

Section: Stentmentioning

confidence: 99%

Management of urolithiasis in pregnancy

et al. 2023

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Urolithiasis is the most common cause of nonobstetric abdominal pain, resulting in 1.7 admissions per 1000 deliveries. Urolithiasis most commonly occurs in the second and third trimesters, with an incidence between 1:125 and 1:2000. Acute urinary system obstructions are challenging to manage in obstetric patients because they contribute to physiological and anatomical changes that result in pathological outcomes. The restricted use of computed tomography in diagnosing and managing urolithiasis is particularly challenging. In addition, a prompt diagnosis is required because the presence of renal calculi during pregnancy increases the risk of fulminating sepsis and preterm delivery. Affected pregnancies are conservatively managed; however, 1 in 4 requires surgical intervention. Indications for surgical interventions are complex and range from nephrostomy insertion to empirical stent placement or ureteroscopy. Therefore, a multidisciplinary approach is required to optimize patient care.The diagnosis and management of urolithiasis in pregnancy are complex. We reviewed the role, safety, advantages and disadvantages of diagnostic tests and treatment used to manage acute urinary obstructions in pregnancy.

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A comparison of adverse pregnancy events between ureteral stents and percutaneous nephrostomy tubes in the treatment of nephrolithiasis during pregnancy: A propensity score-matched analysis of a large multi-institutional research network

Cited by 12 publications

References 22 publications

Pregnancy Outcomes in Patients with Urosepsis and Uncomplicated Urinary Tract Infections—A Retrospective Study

Pregnancy Outcomes in Patients with Urosepsis and Uncomplicated Urinary Tract Infections—A Retrospective Study

Differences in management of pregnant women with obstructing infected ureteral stones: A population‐based analysis

Management of urolithiasis in pregnancy

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