URINARY CALCULI DURING PREGNANCY - WHEN ARE THEY CAUSE FOR CONCERN

Urolithiasis during pregnancy though rare, can be challenging both dia gnostically and therapeutically. It is helpful if the physician is qui ck to suspect the presence of stones in the presence of appropriate si gns and symptoms, particularly flank pain and tenderness, hematuria, o r unresolved bacteriuria. Ultrasonography is the diagnostic imaging me thod of choice, but modified intravenous urography should be performed whenever this study is necessary for a prompt diagnosis. In the absen ce of sepsis, renal failure, or intractable pain, conservative managem ent with hydration, analgesics, and (if infection is present) antibiot ics is the favored initial approach. If conservative management fails, stent insertion or placement of a percutaneous nephrostomy tube may b e appropriate, Ureteroscopy with stone manipulation for distal uretera l stones during pregnancy has also been reported in some cases, If the se methods fail, open surgery should be used for stone removal.