Juan Yung-Shun, Wu Wen-Jeng, Chuang Shu-Mien, Wang Chii-Jye, Shen Jung-Tsung, Long Cheng-Yu, Huang Chun-Hsiung
Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan.
Kaohsiung J Med Sci. 2007 May;23(5):241-6. doi: 10.1016/S1607-551X(09)70404-8.
Urinary calculi during pregnancy present not only a diagnostic challenge but also a management dilemma. In this retrospective study, we describe our experience with diagnosis and management of symptomatic urolithiasis in pregnant women. A total of 18 pregnant women were treated for urolithiasis at the Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, between 1999 and 2004. The incidence of symptomatic urolithiasis during pregnancy was 0.35%. Of the 20 stones found, nine were on the right side and 11 were on the left, and two patients had bilateral urinary stones. Most urolithiasis cases during pregnancy (55.5%) occurred in the third trimester. Flank pain (94.4%) was the most common clinical presentation. Conservative management was successful in 10 patients until the end of pregnancy and then definite treatment was performed. In four patients, a double-J stent was inserted successfully for persistent pain. In three cases with persistent pain, failure of double-J stent placement was treated with ureteroscopic lithotripsy under epidural anesthesia. One patient received percutaneous nephrostomy for persistent renal colic and pyonephrosis. Ultrasonographic evaluation of pregnant women with suspected renal colic is a reasonable diagnostic procedure. Ureteroscopy is another choice when conservative treatment fails.
妊娠期尿路结石不仅带来诊断挑战，还造成治疗困境。在这项回顾性研究中，我们描述了对有症状的孕妇尿路结石进行诊断和治疗的经验。1999年至2004年期间，高雄市小港医院泌尿外科共治疗了18例患有尿路结石的孕妇。妊娠期有症状尿路结石的发病率为0.35%。在发现的20枚结石中，9枚位于右侧，11枚位于左侧，2例患者有双侧尿路结石。妊娠期大多数尿路结石病例（55.5%）发生在孕晚期。胁腹疼痛（94.4%）是最常见的临床表现。10例患者保守治疗成功直至妊娠结束，然后进行确定性治疗。4例患者因持续性疼痛成功置入双J支架。3例持续性疼痛患者，双J支架置入失败后在硬膜外麻醉下进行输尿管镜碎石术治疗。1例患者因持续性肾绞痛和肾积脓接受了经皮肾造瘘术。对疑似肾绞痛的孕妇进行超声评估是一种合理的诊断方法。保守治疗失败时，输尿管镜检查是另一种选择。
