Management of stone disease in pregnancy.
OBJECTIVE
Nephrolithiasis is a not infrequent complication of pregnancy. The occurrence of a stone event in a pregnant woman is a complex situation. Therefore, a clear understanding of the management options available and their relative advantages and disadvantages for this unique population is important.


RESULTS
When initial, conservative measures have failed in the treatment of a pregnant woman suffering from an acute stone event, management options have historically been of a temporizing nature: generally, either ureteral stent placement or nephrostomy drainage. However, with recent advances in surgical technology and surgeon technique, a more definitive approach to these patients has become more widely adopted. Indeed, several recent case series have reported the complication rate for ureteroscopy during pregnancy to be low. Furthermore, a meta-analysis of case series of ureteroscopy during pregnancy suggests definitive endoscopic treatment is well tolerated in this patient population.


CONCLUSIONS
In a pregnant patient without contraindications to ureteroscopy, the definitive endoscopic treatment of an acute stone event is a reasonable management strategy, should conservative measures fail. Although further investigation with randomized control trials is ideally needed to confirm these results, at present, the published case series and meta-analysis confirm the safety of ureteroscopy in pregnant patients in the appropriate setting. A multidisciplinary approach is key to the successful management of this complex patient population.
Semins
Michelle J
MJ
James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Matlaga
Brian R
BR
D000465:Algorithms; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*