RENAL COLIC DURING PREGNANCY - A CASE FOR CONSERVATIVE TREATMENT

Purpose: We defined the merits of early evaluation and conservative tr eatment of pregnant patients admitted with renal colic. Materials and Methods: We retrospectively evaluated 72 pregnancies in 70 patients wh o were hospitalized with the diagnosis of renal colic between 1984 and 1995. Urinalysis was performed in every case. Ultrasound was the prim ary diagnostic test in 65 patients. The patients were followed for 2 w eeks to 3 months after delivery (mean 21 days). Results: Mean patient age at presentation was 27.4 years. The majority of patients were mult iparous (47 of 70) and presented in the third trimester (44 of 70). Mi croscopic urinalysis was not helpful in identifying stone disease in p regnant patients. The sensitivity of ultrasound for the diagnosis of r enal calculi was 95.2%. Watchful conservative nonsurgical treatment re sulted in spontaneous passage of stones in 64.3% of cases. Of the 19 p regnancies in which intervention was necessary cystoscopy and Double-J silicone stent placement were done in 15, and ureteroscopy and stone basketing were done in 4. Two patients, who presented with pyelonephr itis and premature ruptured membranes had fetal loss. Long-term antibi otic prophylaxis was maintained in all stented and bacteriuric patient s. Conclusions: Renal colic in pregnant patients can be complicated by pyelonephritis and premature labor, especially if misdiagnosed or ina dequately treated. Ultrasound is a safe and sensitive diagnostic test. Approximately two-thirds of renal calculi will pass spontaneously. Fo r those who require intervention, placement of a Double-J stent is a s afe and effective option.