Division of Urologic Surgery, The University of Tennessee Medical Center, Knoxville, Tennessee, USA.
J Urol. 2013 Mar;189(3):931-4. doi: 10.1016/j.juro.2012.09.076. Epub 2012 Sep 24.
We determined the optimal imaging study by which to diagnose and treat pregnant patients with suspected urolithiasis.
A retrospective, multicenter study was performed to determine the comparative accuracy of imaging modalities used before the surgical management of suspected urolithiasis in pregnant patients. Patients with a clinical suspicion of urolithiasis were evaluated with directed imaging including renal ultrasound alone, renal ultrasound and low dose computerized tomography, or renal ultrasound and magnetic resonance urography. When indicated, patients underwent therapeutic ureteroscopy. The rate of negative ureteroscopy was determined and the positive predictive values of the imaging modalities were calculated.
A total of 51 pregnant patients underwent ureteroscopy. The mean age of the cohort was 27 years. Mean gestational age was 24.4 weeks. Of the women 24 (47%) underwent renal ultrasound and low dose computerized tomography, 22 (43%) underwent ultrasound alone, and 5 (10%) underwent renal ultrasound and magnetic resonance urography. Negative ureteroscopy occurred in 7 of the 51 patients (14%). The rate of negative ureteroscopy among patients who underwent renal ultrasound alone, renal ultrasound and low dose computerized tomography, and renal ultrasound and magnetic resonance urography was 23%, 4.2% and 20%, respectively. The positive predictive value of computerized tomography, magnetic resonance and ultrasound was 95.8%, 80% and 77%, respectively.
The rate of negative ureteroscopy was 14% among pregnant women undergoing intervention in our series. Of the group treated surgically after imaging with ultrasound alone, 23% had no ureteral stone, resulting in the lowest positive predictive value of the modalities used. Alternative imaging techniques, particularly low dose computerized tomography, offer improved diagnostic information that can optimize management and obviate unnecessary intervention.
我们旨在确定一种诊断和治疗疑似妊娠合并尿路结石患者的最佳影像学检查方法。
本研究为回顾性、多中心研究，旨在比较疑似妊娠合并尿路结石患者接受手术治疗前不同影像学检查方法的准确性。对疑似尿路结石的患者行有针对性的影像学检查，包括单独行肾脏超声检查、肾脏超声联合低剂量计算机断层扫描（CT）检查或肾脏超声联合磁共振尿路成像（MRU）检查。必要时，患者接受输尿管镜治疗。统计输尿管镜检查阴性的概率，并计算影像学检查方法的阳性预测值。
共 51 例妊娠患者接受了输尿管镜检查。该队列的平均年龄为 27 岁，平均妊娠周数为 24.4 周。24 例（47%）患者行肾脏超声联合低剂量 CT 检查，22 例（43%）患者仅行超声检查，5 例（10%）患者行肾脏超声联合 MRU 检查。51 例患者中，有 7 例（14%）输尿管镜检查阴性。单独行肾脏超声、肾脏超声联合低剂量 CT 检查及肾脏超声联合 MRU 检查的患者中，输尿管镜检查阴性的概率分别为 23%、4.2%和 20%。CT、MRU 和超声的阳性预测值分别为 95.8%、80%和 77%。
在我们的研究系列中，接受介入治疗的妊娠妇女中输尿管镜检查阴性的概率为 14%。在影像学检查后仅行超声治疗的患者中，23%的患者没有输尿管结石，这导致了所用影像学方法的阳性预测值最低。替代影像学技术，尤其是低剂量 CT 检查，可提供更多的诊断信息，从而优化管理并避免不必要的干预。
