Valovska Marie-Therese I, Pais Vernon M
Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA.
Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, New Hampshire 03756-1000, USA.
Ther Adv Urol. 2018 Feb 8;10(4):127-138. doi: 10.1177/1756287218754765. eCollection 2018 Apr.
Urolithiasis is the most common nonobstetric complication in the gravid patient. The experience can provoke undue stress for the mother, fetus, and management team. The physiologic changes of pregnancy render the physical exam and imaging studies less reliable than in the typical patient. Diagnosis is further complicated by the need for careful selection of imaging modality in order to maximize diagnostic utility and minimize obstetric risk to the mother and ionizing radiation exposure to the fetus. Ultrasound remains the first-line diagnostic imaging modality in this group, but other options are available if results are inconclusive. A trial of conservative management is uniformly recommended. In patients who fail spontaneous stone passage, treatment may be temporizing or definitive. While temporizing treatments have classically been deemed the gold standard, ureteroscopic stone removal is now acknowledged as a safe and highly effective definitive treatment approach. Ultimately, a multidisciplinary, team-based approach involving the patient, her obstetrician, urologist, radiologist, and anesthesiologist is needed to devise a maximally beneficial management plan.
尿石症是妊娠患者最常见的非产科并发症。这种情况会给母亲、胎儿和管理团队带来不必要的压力。妊娠的生理变化使得体格检查和影像学检查不如典型患者可靠。由于需要谨慎选择影像学检查方式，以最大化诊断效用并最小化对母亲的产科风险以及对胎儿的电离辐射暴露，诊断变得更加复杂。超声仍然是该人群的一线诊断影像学检查方式，但如果结果不明确，也有其他选择。一致推荐进行保守治疗试验。对于结石自然排出失败的患者，治疗可能是临时性的或确定性的。虽然传统上临时性治疗被视为金标准，但输尿管镜取石术现在被认为是一种安全且高效的确定性治疗方法。最终，需要一种多学科、基于团队的方法，涉及患者、她的产科医生、泌尿科医生、放射科医生和麻醉科医生，以制定出最有益的管理计划。
