Endourology and StoneRenal Colic in Pregnancy: Lithiasis or Physiological Hydronephrosis?
Section snippets
Material and Methods
A retrospective chart review study of 300 consecutive patients presenting with renal colic during pregnancy was carried out. The study period was between June 1993 and June 2005. Adequate hospital and follow-up documentation existed for 262 of these patients. Follow-up postdelivery averaged to 2 months and ranged from 2-6 months.
A case was classified as a “documented stone” case if a calculus was identified through imaging, intervention, or spontaneous passage. Cases with demonstrable
Results
There were 262 cases of pregnant women presenting with renal colic, having adequate records of management and follow-up. A total of 144 (55%) of these cases ultimately had a documented stone identified as the likely cause of the symptoms. Most cases occurred in the second (40.1%) and third (56.9%) trimesters. No significant association was found between the trimester of presentation and stone presence, with 62.5%, 53.3%, and 55% of colic cases based on an actual stone in each trimester,
Comment
Of the women presenting with colic, the majority sought attention during the second or third trimesters. Only 8 women were treated during the first 8 weeks of pregnancy. Although there were a greater number of both colic and patients with stone in the third trimester, the trimester of presentation did not significantly alter the proportion of colic cases because of an actual stone. Others have speculated that progressive dilatation of the ureter during pregnancy would allow a greater number of
Conclusions
Although a potentially challenging scenario in pregnancy, an effective approach to the diagnosis and management of renal colic can be implemented. Presenting laboratory values and physical symptoms or signs are generally unhelpful in determining whether a stone is causing the problem. However, left-sided colic is more likely to represent the presence of a stone, with a larger proportion of right-sided hydronephrosis and colic caused by uterine compression. The most appropriate initial
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