Urolithiasis in Pregnancy: Diagnosis, Management, and Pregnancy Outcome

Lewis, David F.; Robichaux, Alfred G.; Jaekle, Ronald; Marcum, Nita G.; Stedman, Charles M.

doi:10.1097/01.ogx.0000074323.48257.83

Cited by 38 publications

(61 citation statements)

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“…Such symptoms include acute flank pain in 90% of cases, haematuria in 75-90%, dysuria and fever [11,13]. The location of the pain often reflects the site of urolithiasis.…”

Section: Discussionmentioning

confidence: 99%

“…However, the effect of the extra solute load is countered by the increased urinary excretion of citrate which is a urolithiasis inhibitor as such the rate of stone formation in pregnant patient is similar to age-matched non pregnant women [9,10]. Stones in pregnant patients are mainly ureteric rather than renal pelvic stone [11]. It predominantly composed of calcium phosphate [12].…”

Section: Discussionmentioning

confidence: 99%

“…Thin-slice, high-resolution, highly T2-weighted fast spin echo improves the chances of MRU in detection of tiny calculi [17]. X-rays, Intra-Venous Urography (IVU) and Computerized Tomography (CT) scan are avoided in pregnancy due to potential fetal teratogenicity associated with high dose of ionizing radiation [11]. Diagnostic radiations in the antenatal period has been associated with the risk of childhood malignancy such as leukemia later in life, with a relative risk of up to 1.92, even though only few studies reported the association of dose of radiation and oncogenic effect.…”

Section: Discussionmentioning

confidence: 99%

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Burden of Symptomatic Renal Stones in Pregnancy Managed Till Normal Delivery: A Case Report in Developing Nation

Tela¹

2016

UNOAJ

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Although urolithiasis occurs in pregnancy, its management remains a great challenge in our region. It creates a diagnostic puzzle due to many differentials that can simulate the symptoms in pregnancy. This is further challenged by the limitations of the accepted imaging investigations, burden of monitoring the pregnancy and managing urolithiasis till delivery at term. We present a case of intractable flank pain due to left renal calculus in an eighteen year old primigravida which was successfully managed. Where possible, treatment of urolithiasis before conception should be our focus in addition to general preventive measures of urolithiasis.Keywords: Urolithiasis; Pregnancy; Stones; Hydronephrosis abdominal pain that requires admission of pregnant patients [3]. Also the risk of pre-term delivery due to nephrolithiasis has doubled the one in pregnant women without nephrolithiasis [2], hence the need for commitment in the management of this category of patients. Maternal kidney stones are significantly associated with several pregnancy complications, including recurrent abortions, hypertensive disorders, gestational diabetes and increase in the number of caesarean deliveries [4]. Urolithiasis in pregnancy may be more common in multiparous women, and more commonly present during the second and third trimesters [5]. Generally, men have been reported in the past to have higher urolithiasis than women, but the overall man to woman ratio were reported later to have decreased from 3.1:1 to 1.3:1 during a 30 year period in a city of united states [6]. The increasing incidence of nephrolithiasis these women might be due to lifestyle associated risk factors, such as obesity. Diagnosing urolithiasis in pregnancy remains a great challenge, because many differential diagnoses can exist in pregnancy, and also the common symptoms and signs may be silent in some patients. We present a case of left ureteric stone in pregnancy. Case PresentationA.A.I was an eighteen year old unbooked primigravida with estimated 3 months old gestation, presented to the Gynaecology Emergency unit with a sudden worsening episode of colicky left flank pain, which preceded several episodes of left flank pain for the past 4 years that were relieved by oral analgesics. No symptoms in the right flank. There was occasional high grade fever with chills, no passage of calculus through the urethra and no Lower Urinary Tract Symptoms (LUTS). Also no hematuria recently or during childhood. There were episodes of vomiting but no other gastro-intestinal symptoms. Gynecological history and other systems were normal. No past history of pelvic surgery. She is not a sickle cell disease or diabetic patient.Examination revealed a young woman, in pain distress, afebrile, not pale, not jaundiced, and not dehydrated and no pedal edema. Vital signs were within normal limit. Abdomen was full, moved with respiration, no tenderness at the renal angle or other parts of the abdomen. The liver and spleen were not enlarged and the kidneys were not ballotable. The uterus ...

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“…Such symptoms include acute flank pain in 90% of cases, haematuria in 75-90%, dysuria and fever [11,13]. The location of the pain often reflects the site of urolithiasis.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Burden of Symptomatic Renal Stones in Pregnancy Managed Till Normal Delivery: A Case Report in Developing Nation

Tela¹

2016

UNOAJ

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“…Renal colic is the most common non-obstetric cause of abdominal pain and subsequent hospitalization during pregnancy (3). The clinical presentation of ureteral stones during pregnancy is primarily after 20 weeks of gestation; alongside renal colic, tenderness, fever, dull aching pain and hematuria (4). As is the case with the general population, a conservative approach that makes use of analgesia and monitoring for spontaneous passage is often the most appropriate initial treatment for acute renal colic in the pregnant patient.…”

mentioning

confidence: 99%

Ureteroscopy in pregnant women with complicated colic pain: Is there any risk of premature labor?

Butticè

Laganà

Vitale

et al. 2017

Arch Ital Urol Androl

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Objective: Clinical presentation of ureteral stones during pregnancy is generally with renal colic pain. The aim of this study is to present our experience in the management of renal colic during pregnancy in emergency settings. Materials and methods: 208 pregnant patients who presented to emergency department with renal colic pain and underwent ureteroscopy (URS) due to failed conservative therapy were enrolled in the study. Urinary tract stones were diagnosed either with ultrasound (US) examination or during URS. Laser lithotripsy and double J (DJ) stent placement were routinely done in all patients with ureteral stones. The incidence of infective complications and premature uterine contractions (PUC) due to URS were compared. Results: No stone was identified in 36.1% (n = 75) of patients with using US and diagnostic URS. Of the remaining 133 patients, 30 (22.6%) had no stone at US but stones were diagnosed during diagnostic URS. The type of anesthesia had no significant effect on PUC. An increased risk of sepsis and PUC was found in patients with fever at the initial presentation. Interestingly, PUC was more frequent in patients with lower serum magnesium levels. There was a significant correlation with time delay until the intervention and the risk of urosepsis and PUC, individually. Conclusions: Ureteroscopy is a safe option for evaluation of pregnant patients with unresolved renal colic. According to the current findings, timing of the operation is the most important factor affecting the septic risks and abortion threat. Surgical intervention with URS must be planned as soon as possible.KEY WORDS: Pregnancy; Urinary calculi; Renal colic. 0.02-0.53%, complicating from 1:200 to 1:2000 pregnancies, and urolithiasis may also be a contributing factor in up to 40% of premature births (2). Several elements are capable of increasing the risk of urolithiasis and hydronephrosis during pregnancy, including the mass-effect of gravid uterus, reduced peristalsis and dilation of the urinary tract due to elevated progesterone levels, and increased risk of infection and electrolyte imbalance (decreased secretion of urinary stone inhibitors, such as citrate and magnesium) (3). Renal colic is the most common non-obstetric cause of abdominal pain and subsequent hospitalization during pregnancy (3). The clinical presentation of ureteral stones during pregnancy is primarily after 20 weeks of gestation; alongside renal colic, tenderness, fever, dull aching pain and hematuria (4). As is the case with the general population, a conservative approach that makes use of analgesia and monitoring for spontaneous passage is often the most appropriate initial treatment for acute renal colic in the pregnant patient. However, if spontaneous passage does not occur or if complications develop, placement of a ureteral stent or a percutaneous nephrostomy is necessary. In such cases, ureteroscopy (URS) has also become a reasonable alternative due to patients' low tolerance for these devices (5). The aim of this study is to present our experience...

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“…5,6 With conservative management, about 70-80% of stones pass spontaneously, may be due to dilated urinary tract during pregnancy. Rest of the cases require further investigations and management.…”

Section: Introductionmentioning

confidence: 99%