title: Our ultrasonographic experience in the management of symptomatic hydronephrosis during pregnancy.
abstract: BACKGROUND
  The aim of the present study was to document the role of ultrasound in the diagnosis and management of symptomatic hydronephrosis during pregnancy.
  
  
  METHODS
  In this study, we reviewed 36 consecutive cases of pregnant women whose pregnancy was complicated by symptomatic hydronephrosis. In all patients, management was initially conservative (analgesics and fluids) after hospitalization. The following criteria were used to indicate double-J stent placement under US guidance rather than a conservative treatment: persistent pain with no improvement after conservative treatment, progressive hydronephrosis (>2 cm dilatation of the renal pelvis) or presence of uterine contractions.
  
  
  RESULTS
  The mean patient's age was 25 years (17-35) and gestational age at clinical presentation was 24 weeks (13-37). 81 % of cases had a renal pelvis dilatation >2 cm, while in only 19 % of cases there was a hydronephrosis between 1 and 2 cm in diameter; however, calculi were confirmed only in 25 patients. 28 patients required an invasive management with double-J stent insertion under US guidance. The sensitivity and specificity of US in the etiological diagnosis of hydronephrosis during pregnancy was 83 and 91 %, respectively.
  
  
  CONCLUSIONS
  Conservative management with medical therapy and observation should be the first-line treatment approach. In our opinion a rapid ureteral decompression with the insertion of a ureteral double-J stent, under US visualization, is the safest method in the treatment of pregnant women with obstructed renal systems.
authors.affiliation: Department of Urology, Arcispedale "S.Anna", University of Ferrara, 8 A. Moro Street, 44124 Cona, Ferrara Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Dell'Atti
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional
keywords: Hydronephrosis; Pregnancy; Stent; Stones; Ultrasound; Ureteroscopy