Butticè Salvatore, Laganà Antonio Simone, Vitale Salvatore Giovanni, Netsch Christopher, Tanidir Yiloren, Cantiello Francesco, Dragos Laurian, Talso Michele, Emiliani Esteban, Pappalardo Rosa, Sener Tarik Emre
Department of Human Pathology - Section of Urology, University of Messina, Messina.
Arch Ital Urol Androl. 2017 Dec 31;89(4):287-292. doi: 10.4081/aiua.2017.4.287.
Clinical presentation of ureteral stones during pregnancy is generally with renal colic pain. The aim of this study is to present our experience in the management of renal colic during pregnancy in emergency settings.
208 pregnant patients who presented to emergency department with renal colic pain and underwent ureteroscopy (URS) due to failed conservative therapy were enrolled in the study. Urinary tract stones were diagnosed either with ultrasound (US) examination or during URS. Laser lithotripsy and double J (DJ) stent placement were routinely done in all patients with ureteral stones. The incidence of infective complications and premature uterine contractions (PUC) due to URS were compared.
No stone was identified in 36.1% (n = 75) of patients with using US and diagnostic URS. Of the remaining 133 patients, 30 (22.6%) had no stone at US but stones were diagnosed during diagnostic URS. The type of anesthesia had no significant effect on PUC. An increased risk of sepsis and PUC was found in patients with fever at the initial presentation. Interestingly, PUC was more frequent in patients with lower serum magnesium levels. There was a significant correlation with time delay until the intervention and the risk of urosepsis and PUC, individually.
Ureteroscopy is a safe option for evaluation of pregnant patients with unresolved renal colic. According to the current findings, timing of the operation is the most important factor affecting the septic risks and abortion threat. Surgical intervention with URS must be planned as soon as possible.
妊娠期输尿管结石的临床表现通常为肾绞痛。本研究的目的是介绍我们在急诊情况下处理妊娠期肾绞痛的经验。
208例因肾绞痛前来急诊科就诊且保守治疗失败后接受输尿管镜检查（URS）的孕妇纳入本研究。通过超声（US）检查或在输尿管镜检查期间诊断尿路结石。所有输尿管结石患者均常规进行激光碎石术和双J（DJ）支架置入术。比较URS导致的感染性并发症和早产宫缩（PUC）的发生率。
在使用US和诊断性URS的患者中，36.1%（n = 75）未发现结石。在其余133例患者中，30例（22.6%）在US检查时未发现结石，但在诊断性URS期间诊断出结石。麻醉类型对PUC无显著影响。初始表现为发热的患者发生脓毒症和PUC的风险增加。有趣的是，血清镁水平较低的患者中PUC更常见。干预延迟时间与尿脓毒症风险和PUC风险分别存在显著相关性。
输尿管镜检查是评估妊娠期未缓解肾绞痛患者的安全选择。根据目前的研究结果，手术时机是影响感染风险和流产威胁的最重要因素。必须尽快计划进行URS手术干预。
