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.