UROLITHIASIS IN PREGNANCY - A CLINICAL CHALLENGE

Symptomatic urolithiasis in pregnancy is a rare event. We present a se ries of 13 cases. Although controversial, we think that X-rays should be avoided if possible. Ultrasound may not be the perfect diagnostic t ool in every case of stone disease, however in pregnancy it is the ima ging of choice and led to an accurate diagnosis in all our cases. Thir ty-eight percent of the patients were managed conservatively throughou t their pregnancy, and another thirty-eight percent of our patients ne eded more extended treatment but could be managed by simple insertion of a double J ureteric stent (DJ). Therefore, in our series invasive t reatment was not necessary in the majority of patients. Each one patie nt required a percutaneous nephrostomy (PCN) and a nephrectomy for a n on-functional pyonephrotic kidney. Urolithiasis in pregnant women cons titutes a challenge for the treating urologists since they are deprive d of some of their essential tools, such as X-rays and extracorporeal shock wave lithotripsy (ESWL), and since normally tolerable complicati ons of less invasive treatments can have disastrous consequences in pr egnant patients. Therefore, decisions on any kind of treatment have to be made very prudently and critically. We present an algorithm for th e management of stones in pregnancy which may be helpful in decision m aking. (C) 1998 Elsevier Science Ireland Ltd.