Parulkar B G, Hopkins T B, Wollin M R, Howard P J, Lal A
Department of Urology, University of Massachusetts and Memorial Hospital, Worcester, USA.
J Urol. 1998 Feb;159(2):365-8. doi: 10.1016/s0022-5347(01)63918-1.
We defined the merits of early evaluation and conservative treatment of pregnant patients admitted with renal colic.
We retrospectively evaluated 72 pregnancies in 70 patients who were hospitalized with the diagnosis of renal colic between 1984 and 1995. Urinalysis was performed in every case. Ultrasound was the primary diagnostic test in 65 patients. The patients were followed for 2 weeks to 3 months after delivery (mean 21 days).
Mean patient age at presentation was 27.4 years. The majority of patients were multiparous (47 of 70) and presented in the third trimester (44 of 70). Microscopic urinalysis was not helpful in identifying stone disease in pregnant patients. The sensitivity of ultrasound for the diagnosis of renal calculi was 95.2%. Watchful conservative nonsurgical treatment resulted in spontaneous passage of stones in 64.3% of cases. Of the 19 pregnancies in which intervention was necessary cystoscopy and Double-J* silicone stent placement were done in 15, and ureteroscopy and stone basketing were done in 4. Two patients, who presented with pyelonephritis and premature ruptured membranes had fetal loss. Long-term antibiotic prophylaxis was maintained in all stented and bacteriuric patients.
Renal colic in pregnant patients can be complicated by pyelonephritis and premature labor, especially if misdiagnosed or inadequately treated. Ultrasound is a safe and sensitive diagnostic test. Approximately two-thirds of renal calculi will pass spontaneously. For those who require intervention, placement of a Double-J stent is a safe and effective option.
我们确定了对因肾绞痛入院的孕妇进行早期评估和保守治疗的优点。
我们回顾性评估了1984年至1995年间因肾绞痛诊断而住院的70例患者中的72次妊娠情况。对每个病例均进行了尿液分析。65例患者中超声是主要诊断检查方法。患者在分娩后随访2周-3个月（平均21天）。
就诊时患者平均年龄为27.4岁。大多数患者为经产妇（70例中的47例），且在孕晚期就诊（70例中的44例）。显微镜下尿液分析对识别孕妇的结石病并无帮助。超声诊断肾结石的敏感性为95.2%。观察性保守非手术治疗使64.3%的病例结石自然排出。在19例需要干预的妊娠中，15例行膀胱镜检查及双J*硅胶支架置入，4例行输尿管镜检查及结石篮取术。2例出现肾盂肾炎和胎膜早破的患者发生了胎儿丢失。所有置入支架和有菌尿的患者均维持长期抗生素预防。
孕妇肾绞痛可并发肾盂肾炎和早产，尤其是误诊或治疗不充分时。超声是一种安全且敏感的诊断检查方法。约三分之二的肾结石会自然排出。对于那些需要干预的患者，置入双J支架是一种安全有效的选择。
Double-J中的未明确其含义，可能是特定的双J支架型号等，暂按原样保留。
