Symptomatic nephrolithiasis complicating pregnancy.

Area of Science:

• Obstetrics and Gynecology
• Urology
• Diagnostic Imaging

Background:

• Nephrolithiasis (kidney stones) complicates approximately 1 in 3300 pregnancies.
• Symptomatic kidney stones during pregnancy require careful diagnosis and management to ensure optimal perinatal outcomes.
• Previous diagnostic methods for nephrolithiasis in pregnancy have varied in efficacy and safety.

Purpose of the Study:

• To review institutional experiences with the diagnosis and management of symptomatic nephrolithiasis in pregnancy.
• To evaluate the diagnostic efficacy of renal sonography compared to plain x-rays and single-shot intravenous pyelography for initial diagnosis.
• To assess perinatal outcomes in pregnant women with nephrolithiasis.

Main Methods:

• A retrospective review of pregnant women admitted for nephrolithiasis between 1986 and 1999.
• Evaluation of diagnostic imaging techniques used, including renal ultrasonography, plain abdominal x-ray, and single-shot intravenous pyelography.
• Analysis of management strategies and perinatal outcomes.

Main Results:

• Fifty-seven pregnant women experienced 73 admissions for symptomatic nephrolithiasis.
• Renal ultrasonography visualized calculi in 60% of cases, while plain x-rays showed 57%.
• Single-shot intravenous pyelography (IVP) had the highest diagnostic yield, identifying calculi in 93% of initial uses. Conservative management was successful in 75% of cases, with interventions including ureteral stents and percutaneous nephrostomy tubes.

Conclusions:

• While renal sonography is safe and convenient for initial diagnosis of nephrolithiasis in pregnancy, it has a significant miss rate (40%).
• When clinical suspicion for nephrolithiasis remains high despite negative or inconclusive sonographic findings, single-shot IVP is recommended for definitive diagnosis.
• Effective management strategies, including conservative measures and interventions, are crucial for favorable perinatal outcomes.