Safety and feasibility of percutaneous nephrolithotomy (PCNL) during pregnancy: A review of literature

Ramachandra, Meghana; Somani, Bhaskar K.

doi:10.5152/tud.2020.20002

Cited by 6 publications

(5 citation statements)

References 33 publications

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“…EAU 2022 guidelines state that its a safe and feasible treatment for patients with persistent symptoms when conservative treatment has failed. 30 Extracorporeal shockwave lithotripsy is an absolute contraindication during pregnancy due to the high complication rates.…”

Section: Discussionmentioning

confidence: 99%

Management of symptomatic urolithiasis during pregnancy: Clinical experience from a tertiary centre

et al. 2022

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Background: Urolithiasis during pregnancy is a complex health problem that can affect maternal and fetal health, needs adequate understanding of the management options available and their relative pros and cons. Patient management needs involvement of obstetrician, radiologist and urologist, as a multidisciplinary team, to avoid any obstetric complications, such as spontaneous abortion and preterm delivery. Aims and Objectives: The aim of the study was to evaluate urolithiasis and its management in pregnant women at our tertiary care center. Materials and Methods: We analyzed data of 45 patients diagnosed with urolithiasis during pregnancy between January 2017 and March 2022.We evaluated patients age, gestational age history of urolithiasis, physical examination findings, routine laboratory findings, location, and size of the stone. The effectiveness and complications of the applied treatment methods were also evaluated. Results: The mean age of 45 patients included in our study was 25 (25.2±4.8) years with mean gestational age of 18.2 weeks. The mean stone size was 10.2 mm and the most common symptom at the time of presentation to hospital was flank pain (73%). Kidney stones were detected in 26 patients and ureteral stones in 19 patients. Although conservative treatment was sufficient in 22 (48.9%) patients, 31 (51.1%) patients required surgical intervention. Major obstetric complications, such as preterm delivery and miscarriage, did not occur in any patients. Conclusion: Urolithiasis during pregnancy can pose a challenge to urologists, obstetricians, and radiologists, requiring a prompt diagnosis and urgent treatment. On failure of medical management, definitive endoscopic treatment of an acute stone event is a reasonable strategy. In determining the treatment options, fetal and maternal health should be of utmost importance.

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Section: Discussionmentioning

confidence: 99%

Management of symptomatic urolithiasis during pregnancy: Clinical experience from a tertiary centre

et al. 2022

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“…Extracorporeal shockwave lithotripsy remains contraindicated in pregnancy, but percutaneous nephrolithotomy (PCNL) is not. There are a few reports of PCNL in the literature, with most of these being done in the supine position with ultrasound-guided kidney puncture [29]. An interesting, though uncommon, dilemma involves a management modality for patients who become pregnant while awaiting definitive stone or PUJO surgery and who already have a ureteric stent or nephrostomy in situ with ongoing significant tube irritation.…”

Section: Treatment Complexitiesmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Navigating the Complexities of Symptomatic Hydronephrosis in Pregnancy

Khalabazyane,

David,

Rashid

et al. 2024

Cureus

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The management of symptomatic hydronephrosis presents substantial challenges due to the absence of consensus within clinical guidelines concerning pain management, diagnostic approaches, therapeutic interventions, and follow-up protocols.This literature review focuses on complexities involving diagnostic challenges that arise from the difficulty in distinguishing physiological from pathological obstruction and treatment complexities that involve deciding on the most appropriate pain management medications and safe interventions while minimizing risks to both the mother and foetus.To address these challenges, a comprehensive search of electronic databases, including PubMed, Embase, and Google Scholar, was conducted for the terms "hydronephrosis", "hydronephrosis in pregnancy", "ionising radiation in pregnancy", and "safe analgesia in pregnancy". Moreover, Mendeley software was used to collect and organize the references.Diagnostic complexities involve selecting the appropriate imaging modality that balances accurate diagnosis with minimal radiation to the foetus. Ultrasound remains the first-line option. However, it has limitations in delineating the underlying aetiology. MRI avoids ionizing radiation but has restricted utility due to foetal movement artifacts. CT provides the highest diagnostic accuracy but raises foetal radiation exposure concerns, though ultra-low dose protocols (<1 mGy) are deemed acceptable by most guidelines.Management includes either a conservative approach, which is a safe option in the majority of cases, or intervention with a percutaneous nephrostomy or ureteric stent insertion, both with comparable symptom control. However, there is no consensus on the optimal frequency for drain changes to prevent rapid encrustation. Definitive procedures like ureteroscopy and percutaneous nephrolithotomies remain controversial. Most guidelines suggest limiting these interventions to specialist centres during the second trimester if required.

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“…The majority of centres perform URS using general or spinal anaesthesia; however, local anaesthesia ± sedation has been reported as a safe alternative in appropriately selected cases [1]. It is especially important to avoid general anaesthesia in the first trimester as use of volatile gases carries risk of causing morphogenetic anomaly [41].…”

Section: Ureteroscopymentioning

confidence: 99%

“…While there have been several case reports (less than 20 in world literature to date) of successful PCNL being performed in pregnancy, it is not currently part of standard practice not least because of the difficult patient positioning, e.g. prone, need for general anaesthesia and fluoroscopy [41].…”

Section: Percutaneous Nephrolithotomy (Pcnl)mentioning

confidence: 99%

Management of Kidney Stone Disease in Pregnancy: A Practical and Evidence-Based Approach

et al. 2022

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Purpose of Review Suspected kidney stone disease during pregnancy is a difficult condition for health professionals to manage. This is partly due to the more limited range of diagnostic and therapeutic strategies, which can be safely applied. A comprehensive review of literature was performed to identify evidence to develop a practical guide to aid clinicians. Recent Findings Ultrasound remains the recommended first line option for imaging. Complicated cases, such as suspected infected obstructed system, require urgent decompression such as in the form of percutaneous nephrostomy. This article highlights the pharmacotherapeutic agents, which are considered safe for use in pregnancy. Where surgical intervention is indicated, evidence supports ureteroscopy to be a safe option as long as infection has been treated. Ureteroscopy can offer definitive clearance of the stone(s) and can be less burdensome regarding bothersome symptoms compared to indwelling ureteral stent or nephrostomy, which also require regular exchange due to the high propensity for encrustation in pregnancy. Summary A multidisciplinary approach is fundamental to safely manage suspected kidney stone disease in pregnancy. Adoption of a locally agreed pathway as suggested in this article supports improved patient care.

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Safety and feasibility of percutaneous nephrolithotomy (PCNL) during pregnancy: A review of literature

Abstract: I n d e x e d i n P u b M e d , W e b o f S c i e n c e a n d S c o p u s Pankaj M. Joshi and Sanjay B. Kulkarni. A new technique of double-face buccal graft urethroplasty for female urethral strictures.

Cited by 6 publications

References 33 publications

Management of symptomatic urolithiasis during pregnancy: Clinical experience from a tertiary centre

Management of symptomatic urolithiasis during pregnancy: Clinical experience from a tertiary centre

Navigating the Complexities of Symptomatic Hydronephrosis in Pregnancy

Management of Kidney Stone Disease in Pregnancy: A Practical and Evidence-Based Approach

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