Management of ureteric stone in pregnancy: a review

African Journal of Urology - Tập 26 Số 1 - 2020
Avinash Pratap Singh Thakur1, Vivek Sharma2, Vasantharaja Ramasamy3, Arpan Choudhary1, Prashant Patel1, Sangeeta Singh4, Subeesh Parol3
1Department of Urology, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, M.P., India
2Department of Urology, Super Speciality Hospital, Shyam Shah Medical College, Rewa, M.P., India
3Department of Urology, Super Speciality Block, Government Medical College Thiruvananthapuram, Thiruvananthapuram, Kerala, India
4Triveni Institute of Dental Sciences Hospital and Research Centre Bilaspur, Bilaspur, C.G., India

Tóm tắt

Abstract 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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