Management of Urolithiasis in Pregnancy: Study from a Rural Centre

Introduction: Kidney stones are very common and do not spare the pregnant population. Pathological and physiological changes occur in the pregnancy which alter the risk for development of urolithiasis. Urological emergencies that occur during pregnancy are associated with severe risks to both mother and the fetus. Diagnosis is challenging as imaging options without radiation are limited especially in the rural settings. Management of urolithiasis in the pregnant females is unique and requires utmost care. We share our experience of managing the urolithiasis in pregnant females at our rural centre.

Materials and Methods: All the patients who came to the causality and the outpatient department of Tambe hospital, Sangamner, Maharashtra from August 2016 to July 2019 were included in the study. A total of 39 patients were included and studied. The records of the patients were reviewed to collect data that included age, symptoms, the laterality of renal colic, sizes and locations of urolithiasis, trimester of diagnosis, pain before and after treatment and pregnancy complications.

Results: Based on clinical and sonological diagnoses, 13 patients had urolithiasis, and 13 patients had hydronephrosis without definite evidence of calculi. Conservative treatments were successful in 25 patients. Among these treatments, antibiotics were used in 15 patients, and the remaining patients received only hydration and analgesics without antibiotics. Urological interventions were required in 14 patients. The most common intervention was double J stenting, which was performed in 13 patients to treat hydronephrosis or urolithiasis. Percutaneous nephrostomy was done in only one patient. No complications were noted.

Conclusion: Urolithiasis during pregnancy is more complex than urolithiasis in general population. Diagnosis is challenging. Conservative management is first-line of treatment. If it fails, then both diversion and definitive treatment are acceptable management options. Patient and surgeon’s preferences, along with clinical variables and available resources, guide decision-making.