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Management of stone disease in pregnancy

Semins, Michelle J; Matlaga, Brian R

Current Opinion in Urology:
doi: 10.1097/MOU.0b013e3283353a4b
Urolithiasis: Edited by David A. Tolley
Abstract

Purpose of review: Nephrolithiasis is a not infrequent complication of pregnancy. The occurrence of a stone event in a pregnant woman is a complex situation. Therefore, a clear understanding of the management options available and their relative advantages and disadvantages for this unique population is important.

Recent findings: 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.

Summary: 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. Although further investigation with randomized 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.

Author Information

James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Correspondence to Brian R. Matlaga, MD, MPH, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21209, USA Tel: +1 410 550 3506; fax: +1 410 550 3341; e-mail: bmatlaga@jhmi.edu

© 2010 Lippincott Williams & Wilkins, Inc.