The experience with diagnosis and therapy of urolithiasis in pregnancy

Objective: to assess owvn experience with diagnosis and treatment of urolithiasis in pregnancy



Material and methods: 21 pregnant vomen (average age 21 years, range 21–39 years) was evaluated in retrospective analysis. The localisation

of stones were: ureter (in 17/21 (81 %)), kidney (in 4/21 (19 %)), right (in 16 (76 %)), left (in 5/21 (24 %)) pregnant patients. Positive

history of urolithiasis (before pregnancy) was noted in 4/21 (19 %) women. Symptoms of urolithiasis were: flank pain (in 14/21 (66 %)),

flank pain plus fever more than 38 °C (in 5/21 (24 %)), gross hematuria (in 1/21 (5 %)) and irritative lower urinary tract symptoms (in 1/21

(5 %)). Diagnosis is based on history, physical examination, laboratory examination and ultrasonography. Treatment of urolithiasis in

pregnancy: active expectant management with supportive care (appropriate hydration, analgesia, antibiotics, etc.) in 11/21 (53 %), ureteral

stent in 7/21 (33 %) and percutaneous nephrostomy in 3/14 (14 %) patients.

Results: 10/21 (48 %) patients passed their stones spontaneously. Definitive treatment (ureteroscopic management in 8/21 (38 %)and

extracorporeal shock wave lithotripsy in 3/21 (14 %)) were performed safely and and effectively in post partum period. Complications:

irritative lower urinary tract symptoms in 5/7 (71 %), rapid stent encrustation in 2/7 (29 %), and fever more than 38 °C in 1/7 (14 %) after

indweling uereteral stent. Short – lasting gross hematuria was noted in 1/3 (33 %) women with percutaneous nephrostomy. There was

no recorded any serious complication of pregnancy or childbearing.

Conclusion: Diagnosis and therapeutic management of urolithiasis in pregnancy is not too easy. Ultrasonography remains the cornerstone

of imaging of urinary tract in pregnant women. There was confirmed, that more (48 % in this group of patients) stones passed

spontaneously (still during a pregnancy or in the postpartum period). Active management with supportive care were a basal treatment

strategy in a pregnant women with urolithiasis. Temporary urinary drainage (indwelling ureteral stent placement, or percutaneous

nephrostomy) was effective resolution in a cases of incipient pyonephrosis/urosepsis, and intractable pain. Definitive treatment (endoscopic

manipulation, extracorporeal shock wave lithotripsy) were higly effective and safe (with minimal complicatons) in a postpartum

period also. Prompt diagnosis, adequate therapy and interdisciplinary collaboration (between urologist, radiologist and obstetrician)

are strictly required for the possibilty of an excellent, stone free outcome.

Keywords: urolithiasis, pregnancy, diagnosis, treatment.