Buchholz N P, Biyabani R, Sulaiman M N, Talati J
Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
Eur J Obstet Gynecol Reprod Biol. 1998 Sep;80(1):25-9. doi: 10.1016/s0301-2115(98)00074-8.
Symptomatic urolithiasis in pregnancy is a rare event. We present a series of 13 cases. Although controversial, we think that X-rays should be avoided if possible. Ultrasound may not be the perfect diagnostic tool in every case of stone disease, however in pregnancy it is the imaging of choice and led to an accurate diagnosis in all our cases. Thirty-eight percent of the patients were managed conservatively throughout their pregnancy, and another thirty-eight percent of our patients needed more extended treatment but could be managed by simple insertion of a double J ureteric stent (DJ). Therefore, in our series invasive treatment was not necessary in the majority of patients. Each one patient required a percutaneous nephrostomy (PCN) and a nephrectomy for a non-functional pyonephrotic kidney. Urolithiasis in pregnant women constitutes a challenge for the treating urologists since they are deprived of some of their essential tools, such as X-rays and extracorporeal shock wave lithotripsy (ESWL), and since normally tolerable complications of less invasive treatments can have disastrous consequences in pregnant patients. Therefore, decisions on any kind of treatment have to be made very prudently and critically. We present an algorithm for the management of stones in pregnancy which may be helpful in decision making.
妊娠期有症状的尿路结石是一种罕见情况。我们报告了一系列13例病例。尽管存在争议，但我们认为应尽可能避免使用X射线。超声在每种结石病病例中可能并非完美的诊断工具，然而在妊娠期它是首选的影像学检查方法，并且在我们所有病例中都能做出准确诊断。38%的患者在整个孕期接受保守治疗，另外38%的患者需要更广泛的治疗，但可通过简单置入双J输尿管支架（DJ）来处理。因此，在我们的病例系列中，大多数患者无需进行侵入性治疗。有一名患者因无功能的积脓肾需要进行经皮肾造瘘术（PCN）和肾切除术。孕妇尿路结石对治疗泌尿外科医生构成了挑战，因为他们无法使用一些基本工具，如X射线和体外冲击波碎石术（ESWL），而且由于通常耐受性良好的侵入性较小的治疗的并发症在孕妇中可能会产生灾难性后果。因此，对任何治疗方式的决策都必须非常谨慎和审慎。我们提出了一种妊娠期结石处理的算法，这可能有助于决策。
