Kidney stone disease and pregnancy: the features of the obstetric clinical management

Abstract

Annotation. The article presents the results of a structured review of ukranian and foreign literary sources in the search databases PUBMED, EMBASE, Google Scholar, UpToDate, Web of Science, Scopus regarding the problem of urolithiasis during pregnancy over the past 15 years. The search was carried out using the terms “pregnancy”, “urolithiasis and pregnancy”, “renal colic” separately and in combination with “stone”, “kidney stone”, “ultrasound examination”, “magnetic resonance imaging”, “computed tomography”, “percutaneous nephrostomy”, “ureteral stent”, “ureteroscopy". The additional publications were identified by reviewing the reference lists of relevant articles identified in the first literature search. A total of 47 articles were included. There were found that this pathology is the most common non-obstetrical cause of hospitalization of pregnant women and is diagnosed in 80-90% in the II-III trimesters, when the disease has a course with the most extensive clinical scenario. Ultrasound remains the recommended first-line imaging option. Complicated cases, such as suspected infected obstructed system, require urgent decompression such as in the form of percutaneous nephrostomy. This review highlights conservative treatment that have been considered safe for use during pregnancy. If surgery is indicated, the evidence supports that ureteroscopy is a safe option if the infection has been treated. Ureteroscopy may offer definitive removal of the stone(s) and may be less burdensome in terms of unpleasant symptoms compared to a permanent ureteral stent or nephrostomy, which also require regular replacement due to the high propensity for encrustation during pregnancy. The approach to the management of nephrolithiasis during pregnancy has certain difficulties, since the use of diagnostic and therapeutic methods is limited. Management of this category of patients always requires a multidisciplinary approach, depends on the presence of complications and requires careful observation of patients throughout pregnancy.