Renal Colic In Pregnancy: Lithiasis Or Physiological Hydronephrosis?

Main Category: Pregnancy / Obstetrics
Also Included In: Urology / Nephrology
Article Date: 06 Dec 2009 - 0:00 PDT

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This is a wonderfully comprehensive article on urolithiasis in pregnancy and is filled with pearls based on the authors' experiences with 300 such patients. Valuable clinical take home points include:

a.) One can improve the accuracy of an ultrasound diagnosis of a stone from 56% to 72% by looking for additional indications of obstruction such as the absence of ureteral jets and/or elevated resistive indices.

b.) Colic on the left is more commonly associated with stones (65% vs. 47%) likely due to the cushioning effects of the left colon.

c.) Ureteroscopy is safe and resolved the stone problem in 88% of patients. There was one ureteral perforation; holmium laser lithotripsy is preferred.

d.) As with other smaller studies, fortunately only 3% of the cases occurred during the first trimester.

e.) Ultrasonography is the first line study. If it proves inconclusive, a limited 3 shot IVP was performed and provided an accurate diagnosis in 89%.

f.) Overall 64% of the patients passed their stones spontaneously. Stents were placed in 15%, ureteroscopy was performed in 9%, and only 2% came to placement of a nephrostomy tube. Of note, nearly 2/3rds of the stents were placed during the third trimester; among these patients, almost half poorly tolerated the stent. Given the high success of ureteroscopy and the need to rarely place a post ureteroscopy stent, it would appear that ureteroscopy may be a better alternative than stent placement when intervention is required, especially in the third trimester.

g.) Among patients with an indwelling stent, periodic ultrasonography was performed every 6-8 weeks in order to detect encrustation requiring stent exchange. As such, stent changes were required in only 22% of their patients.

Andreoiu M, Macmahon R

Urology. 2009 Aug 4. Epub ahead of print.
doi:10.1016/j.urology.2009.03.054

Written by UroToday.com Medical Editor Ralph V. Clayman, MD

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice. To access the latest urology news releases from UroToday, go to: www.urotoday.com

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