engleski

Urolithiasis as reason for renal colic in pregnant women

Renal colic is not a uncommon event during pregnancy. Colic can be provoked with passage of stones, but there is more common physiological right hydronephrosis in pregnancy. Elevated levels of progesterone as suppressor of ureter contractility and crude mechanical pressure of fetus on ureter are suggested mechanisms. Diagnosis of stone disease is achieved with ultrasound, although with low detection rates. Treatment is conservative with placement of double J stent or nephrostomy and double J stent should be changed every 6-8 weeks due to higher incrustation rate. Recently, ureterorenoscopy (URS) is being advocated with excellent results, only in cases if stone is confirmed. At our Department we place double J stent on indication in pregnant women and we don't perform URS in pregnant women. Total of 25 women were treated with stent placement in last 4 years. All attempts of stent placement were successful, no nephrostomy was performed, nor stents were changed during pregnancy on regular basis, since stents were placed in advanced pregnancy. Diagnostic algorithm included anamnesis, ultrasound and laboratory. If persistent pain, fever, vomitus, hydronephrosis or elevated laboratory markers were found or progressed, double J stent was placed. Radiological workup was performed after delivery and, if needed, definitive treatment was done. Two groups were constructed based on confirmed stone after delivery: Group 1. - patients in whom lithiasis was found after delivery ; Group 2. - no lithiasis was found. Stone disease was confirmed in only 8 patients after delivery. Median week of gestation during presentation was 26 (15-37). Previous urological operation or stone disease was found in 3 patients, all in Group 1., also in two patients incrustation of stent occurred, also both in Group 1. Most common symptom was loin pain (in 24/25 patients) followed with fever in 10/25 patients. Right side was predominant (in 21 cases), inflammation was found in 18 cases in urine analysis and positive urine culture was found in 7 cases. In laboratory average elevated CRP was found (52.1 mg/L) and leukocyte count (12.4xl09/L), while blood urea and creatinine were normal. Stent incrustation was found in two patients, both in Group 1. Positive previous urological history was found only in Group 1. (lithiasis group) and this is significant when compared to Group 2. (p=0.050). No difference was determined between groups for other analyzed variables. Only 32% of our patients presented with renal colic during pregnancy had confirmed stone disease after delivery. Some uncertainty in spontaneous passage after delivery is present, but this is still low, when compared to published data. Previous urological surgery or stone disease in medical history is found to be a good predictor of stone disease as reason for renal colic in pregnant women.

urolithiasis; pregnancy; management

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