Management of stone disease in pregnancy
Thursday, 4 February 2010- Nephrolithiasis is a not infrequent complication of pregnancy. The occurrence of a stone event in a pregnant woman is a complex situation. Semins and colleagues reviewed the management of stone disease in pregnancy in a report published in the March edition of the journal Current Opinion in Urology.
"A clear understanding of the management options available and their relative advantages and disadvantages for this unique population is important," the authors wrote.
The authors said that when initial, conservative measures have failed in the treatment of a pregnant woman suffering from an acute stone event, management options have historically been of a temporizing nature: generally, either ureteral stent placement or nephrostomy drainage.
However, with recent advances in surgical technology and surgeon technique, a more definitive approach to these patients has become more widely adopted. Indeed, several recent case series have reported the complication rate for ureteroscopy during pregnancy to be low. Furthermore, a meta-analysis of case series of ureteroscopy during pregnancy suggests definitive endoscopic treatment is well tolerated in this patient population.
"In a pregnant patient without contraindications to ureteroscopy, the definitive endoscopic treatment of an acute stone event is a reasonable management strategy, should conservative measures fail," wrote Semins and colleagues.
They added that although further investigation with randomised control trials is ideally needed to confirm these results, at present, the published case series and meta-analysis confirm the safety of ureteroscopy in pregnant patients in the appropriate setting.
"A multidisciplinary approach is key to the successful management of this complex patient population," the authors said.
Source: Semins, Michelle J; Matlaga, Brian R, "Management of stone disease in pregnancy," Current Opinion in Urology: March 2010 - Volume 20 - Issue 2 - p 174–177, doi: 10.1097/MOU.0b013e3283353a4b
