Elsevier

Urology

Volume 74, Issue 4, October 2009, Pages 757-761
Urology

Endourology and Stone
Renal Colic in Pregnancy: Lithiasis or Physiological Hydronephrosis?

https://doi.org/10.1016/j.urology.2009.03.054Get rights and content

Objectives

To assess the reliability and accuracy of diagnostic investigations in differentiating urinary calculi from physiological hydronephrosis as the cause of renal colic. The appropriateness and efficacy of the treatments used were was also examined.

Methods

A retrospective review of 300 consecutive patients presenting to 2 local hospitals was carried out. Descriptive and correlational data on clinical presentation, diagnostic imaging, and interventions undertaken were analyzed. A total of 262 patients were included in the final analysis.

Results

Most clinical or laboratory features were unhelpful in predicting the presence of a stone. Left-sided colic was more likely to indicate presence of stone (64.9% vs 46.6%, P = .003). The accuracy of ultrasound findings in predicting presence of stone improved (from 56.2% to 71.9%) when features of obstruction, such as ureteric jet absence and an elevated resistive index (RI), were included in the assessment. Spontaneous resolution occurred in a smaller proportion of patients with stone (63% vs 85%, P <.001). The need for intervention was more prevalent in patients with stones (29.2% vs 5.9%, P <.001). Stent insertion was the most common intervention and was usually completed successfully (95.5%). Ureteroscopy was safe and resulted in stone retrieval 88% of the time.

Conclusions

Most clinical signs and symptoms are unhelpful in determining the cause of colic symptoms. Left-sided colic is more likely to represent the presence of a stone. An enhanced ultrasound examination is a reasonably accurate initial study. The standard endoscopic interventions are more likely to be used in colic cases because of actual calculi, and are safe and effective throughout pregnancy.

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

References (22)

  • N.M. Ulvik et al.

    Ureteroscopy in pregnancy

    J Urol

    (1995)
  • Cited by (0)

    View full text