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Urolithiasis in pregnancy--a clinical challenge
N P Buchholz1, R Biyabani, M N Sulaiman
1Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan. niels@cyber.net.pk
Summary
Symptomatic urolithiasis (kidney stones) in pregnancy is rare. Ultrasound is the preferred imaging, with most patients managed conservatively or with ureteric stents, avoiding invasive procedures.
Area of Science:
- Urology
- Obstetrics
Background:
- Symptomatic urolithiasis during pregnancy presents unique diagnostic and management challenges.
- Limited imaging modalities and potential complications necessitate careful treatment strategies.
Purpose of the Study:
- To present a series of 13 cases of symptomatic urolithiasis in pregnancy.
- To evaluate diagnostic and treatment approaches for kidney stones in pregnant patients.
- To propose a management algorithm for urolithiasis in pregnancy.
Main Methods:
- Retrospective case series of 13 pregnant patients with urolithiasis.
- Utilized ultrasound as the primary diagnostic imaging modality.
- Documented conservative management, double J ureteric stent (DJ) insertion, percutaneous nephrostomy (PCN), and nephrectomy outcomes.
Main Results:
- Ultrasound provided accurate diagnosis in all cases.
- 38% of patients managed conservatively; 38% required DJ stent insertion.
- Only one patient needed PCN and another underwent nephrectomy for a non-functional kidney.
Conclusions:
- Ultrasound is the imaging modality of choice for urolithiasis in pregnancy.
- Conservative management and DJ stenting are effective for the majority of cases.
- Invasive treatments are rarely necessary, but careful, critical decision-making is paramount.