Anesthetic Exposure in the Treatment of Symptomatic Urinary Calculi in Pregnant Women

Rivera, Marcelino; McAlvany, Kelly L.; Brinton, Thomas S.; Gettman, Matthew T.; Krambeck, Amy E.

doi:10.1016/j.urology.2014.07.007

Cited by 20 publications

(20 citation statements)

References 7 publications

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“…According to a study, 7 out of 15 pregnant females with DJ stents required early induction secondary to stent intolerance [98]. The efficacy and safety of alpha blockers and antimuscarinics are not proven in pregnancy, so they should be used with caution to reduce stent-related lower urinary tract symptoms [99].…”

Section: Stentmentioning

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: Stentmentioning

confidence: 99%

Management of ureteric stone in pregnancy: a review

et al. 2020

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“…Indwelling stents may be poorly tolerated, however, and are at a high risk of bacterial colonization and encrustation. 43 Stent encrustation can result in obstruction requiring further surgical management, and as such stents require exchange every 4-6 weeks in pregnant patients. 31,43,44 Placement of nephrostomy tubes has been shown to be safe in numerous studies, though they come with similar limitations as stents.…”

Section: Surgical Risk In Pregnancymentioning

confidence: 99%

“…43 Stent encrustation can result in obstruction requiring further surgical management, and as such stents require exchange every 4-6 weeks in pregnant patients. 31,43,44 Placement of nephrostomy tubes has been shown to be safe in numerous studies, though they come with similar limitations as stents. 45,46 Advances in endourology have improved the safety and efficacy of ureteroscopic management of stones in pregnancy.…”

Section: Surgical Risk In Pregnancymentioning

confidence: 99%

“…51 Another case series (n=26) found no difference in pregnancy outcomes between stented and unstented patients post ureteroscopy. 43 Extracorporeal shockwave lithotripsy (ESWL) is absolutely contraindicated in pregnancy due to fetal death and malformations observed in animal studies. 52,53 Percutaneous nephrolithotomy (PCNL) is considered contraindicated in the pregnant patient due to the need for general anesthetic, patient positioning, and prolonged need for fluoroscopy.…”

Section: Surgical Risk In Pregnancymentioning

confidence: 99%

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Urological issues in pregnancy: A review for urologists

White

Ory

Powers

et al. 2020

CUAJ

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Urological issues in the pregnant patient present a unique clinical dilemma. These patients may be challenging to treat due to risks associated with medications and surgical procedures. This review aims to provide an update on the physiological changes and surgical risks in pregnancy. In addition, we review the approach for management of urolithiasis and urinary tract infections (UTIs) in pregnancy. Lastly, we highlight the importance of a multidisciplinary approach to placenta percreta, a condition not commonly addressed in urological education.

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“…One study of 26 women with urolithiasis found that 7 out of 15 women with stents required early induction secondary to stent intolerance. 70 Alpha blockers and antimuscarinics may be offered to nonpregnant patients to reduce stent discomfort, but their efficacy and appropriateness in the pregnant patient is unclear. 71 Furthermore, stents may be subject to bacterial colonization (increasing the risk of ascending urinary tract infection) as well as to migration and encrustation.…”

Section: Management Of Stones In the Pregnant Patientmentioning

confidence: 99%

Contemporary best practice urolithiasis in pregnancy

Valovska

Pais

2018

Therapeutic Advances in Urology

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Urolithiasis is the most common nonobstetric complication in the gravid patient. The experience can provoke undue stress for the mother, fetus, and management team. The physiologic changes of pregnancy render the physical exam and imaging studies less reliable than in the typical patient. Diagnosis is further complicated by the need for careful selection of imaging modality in order to maximize diagnostic utility and minimize obstetric risk to the mother and ionizing radiation exposure to the fetus. Ultrasound remains the first-line diagnostic imaging modality in this group, but other options are available if results are inconclusive. A trial of conservative management is uniformly recommended. In patients who fail spontaneous stone passage, treatment may be temporizing or definitive. While temporizing treatments have classically been deemed the gold standard, ureteroscopic stone removal is now acknowledged as a safe and highly effective definitive treatment approach. Ultimately, a multidisciplinary, team-based approach involving the patient, her obstetrician, urologist, radiologist, and anesthesiologist is needed to devise a maximally beneficial management plan.

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Anesthetic Exposure in the Treatment of Symptomatic Urinary Calculi in Pregnant Women

Cited by 20 publications

References 7 publications

Management of ureteric stone in pregnancy: a review

Management of ureteric stone in pregnancy: a review

Urological issues in pregnancy: A review for urologists

Contemporary best practice urolithiasis in pregnancy

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