Department of Urology, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
J Endourol. 2024 Oct;38(10):1092-1096. doi: 10.1089/end.2024.0012. Epub 2024 Aug 7.
Kidney stones in pregnant is not a common emergency, but it is one that is extremely challenging to manage. There exists no previous survey, which maps the different practice patterns adopted. Our aim was to deliver a survey to evaluate the current status of practice patterns across different parts of the world regarding the management of stone disease in pregnancy. Through an iterative process, 19-item survey was devised. This contained the following five sections: (1) Demographics, (2) General items, (3) Diagnosis and Imaging, (4) Initial management, (5) Surgery. It was disseminated via social media and email chains. A total of 355 responses were collected, and the majority (66.2%) reported no established hospital protocol for stones in pregnancy. Ultrasound was the most popular first line imaging choice (89.9%) but 8% would choose non-contrast CT. The latter was also chosen as second line choicer in 34.6% as opposed to magnetic resonance imaging. A large proportion (42.5%) had requested CT in pregnancy previously. With equivocal ultra sound results, only 19.4% would proceed to ureteroscopy (URS) but 40.9% would opt for CT. Twenty-four-48 hours were the most popular (37.6%) time period to observe before surgical intervention. Ureteral stent and nephrostomy were regarded as equally effective, and 6 weeks was most popular frequency for an exchange. Most do not use fetal heart rate monitoring intraoperatively. A total of 3.94% had previously performed percutaneous nephrolithotomy during pregnancy. Practice patterns vary widely for suspected kidney stones in pregnancy and use of CT appears increasingly popular. This includes when faced with equivocal ultrasound results and instead of proceeding to ureteroscopy. Most hospitals lack an established management protocol for this scenario.
孕妇肾结石并不常见，但却是一种极具挑战性的急症。目前尚无调查研究能够明确不同地区的实践模式。我们的目的是通过调查评估全世界不同地区在妊娠期间管理结石病的实践模式现状。通过迭代过程，我们设计了一个包含 19 个项目的调查问卷。该问卷分为五个部分：（1）人口统计学，（2）一般项目，（3）诊断和影像学，（4）初始管理，（5）手术。该问卷通过社交媒体和电子邮件链进行分发。共收集到 355 份回复，其中大多数（66.2%）医院未制定针对妊娠结石的固定方案。超声是最受欢迎的一线影像学检查选择（89.9%），但 8%的人会选择非增强 CT。而非增强 CT 也被 34.6%的人选择作为二线选择，而不是磁共振成像。相当一部分（42.5%）之前曾在妊娠期间要求进行 CT 检查。在超声结果不确定的情况下，只有 19.4%的人会进行输尿管镜检查（URS），但 40.9%的人会选择 CT。最受欢迎的观察时间是 24-48 小时（37.6%），然后再进行手术干预。输尿管支架和肾造口术被认为同样有效，最受欢迎的更换频率是 6 周。大多数人在手术过程中不进行胎儿心率监测。共有 3.94%的人之前在妊娠期间进行过经皮肾镜取石术。对于疑似孕妇肾结石，实践模式差异很大，且 CT 的使用似乎越来越受欢迎。这包括在面对不确定的超声结果时，而不是选择输尿管镜检查。大多数医院缺乏针对这种情况的既定管理方案。
