From the Guidelines
Kidney stones during pregnancy should be managed with careful consideration of the potential risks to both mother and baby, and treatment typically begins with conservative approaches, with ureteroscopy being the preferred procedure for severe cases. The management of kidney stones during pregnancy is crucial to prevent complications such as urinary tract infections and preterm labor. According to the American Urological Association/Endourological Society guideline, part I 1, in pregnant patients with ureteral stones and well-controlled symptoms, clinicians should offer observation as first-line therapy.
Key Considerations
- Increased fluid intake (2-3 liters of water daily) is recommended to help pass smaller stones
- Pain management with acetaminophen (Tylenol) is the safest option
- Alpha-blockers like tamsulosin may be used to help pass smaller stones
- Imaging studies to diagnose stones during pregnancy usually involve ultrasound rather than CT scans to avoid radiation exposure
- For severe cases with infection, obstruction, or intractable pain, surgical intervention may be necessary, with ureteroscopy being the preferred procedure during pregnancy
Prevention and Risks
- Prevention includes maintaining hydration, limiting sodium intake, and consuming adequate calcium through diet rather than supplements
- Kidney stones during pregnancy can increase risks of urinary tract infections and preterm labor, making prompt treatment essential
- The obstetrician and urologist will work together to develop the safest treatment plan for the specific situation, as recommended by the American Urological Association/Endourological Society guideline, part I 1 and the ACR Appropriateness Criteria for acute onset of flank pain with suspicion of stone disease 1.
From the Research
Diagnosis and Management of Kidney Stones in Pregnancy
- Kidney stones in pregnancy are a complex condition to manage, with limited diagnostic and therapeutic strategies that can be safely applied 2, 3, 4.
- Ultrasound is the recommended first-line imaging option for suspected kidney stones in pregnancy, due to its safety and effectiveness 2, 3, 5.
- Complicated cases, such as suspected infected obstructed systems, require urgent decompression, which can be achieved through percutaneous nephrostomy 5.
- Initial management of kidney stones in pregnancy is generally conservative, with a trial of passage and pain management, and is associated with a high rate of stone passage 3, 6.
Surgical Intervention and Treatment Options
- Ureteroscopy is a safe and effective treatment option for kidney stones in pregnancy, as long as infection has been treated, and can offer definitive clearance of the stone(s) 6, 5.
- Ureteral stent placement and nephrostomy drainage are also treatment options, but may require regular exchange due to the high propensity for encrustation in pregnancy 2, 6, 5.
- Shockwave lithotripsy and percutaneous nephrolithotomy are contraindicated during pregnancy 3.
Multidisciplinary Approach and Patient Care
- A multidisciplinary approach is fundamental to safely managing suspected kidney stone disease in pregnancy, and involves collaboration between healthcare professionals to develop a comprehensive treatment plan 4, 6, 5.
- Adoption of a locally agreed pathway can support improved patient care and outcomes for women with kidney stones in pregnancy 5.