Post Date December, 03 2023
Pregnancy is a joyful and happy thing, and expectant mothers take great care of their babies even if they work very hard. However, many times they find mothers with kidney stones during pregnancy. This disease is called pregnancy with stones. The main symptoms include lower back pain, nausea, vomiting, fever, and kidney colic.
Due to the teratogenic effects of X-rays on the fetus, it is prohibited for patients with pregnancy complicated by stones to undergo X-ray, including CT examination. MRI examination is safe for patients with renal failure and fetuses, especially for hydronephrosis caused by stones. Magnetic resonance urography (MRU) can clearly display the dilated collection system and the location of obstruction. B-ultrasound has a high diagnostic accuracy for stones and is not harmful to the fetus. It can be repeatedly applied and is the preferred method. It is not difficult to diagnose urinary tract stones by combining B-ultrasound and urine routine examination with clinical manifestations.
Conservative treatment is the first choice for pregnancy complicated with stones, and the treatment method should be determined based on the size of the stones, the location of obstruction, the presence of infection, renal parenchymal damage, and clinical symptoms. In principle, for those with small stones that do not cause serious renal function damage, comprehensive stone removal treatment should be adopted, including measures such as drinking more water, increasing activity appropriately, infusion diuresis, spasmolysis, pain relief, and anti infection to promote stone removal.
For patients with gestational stones, maintaining unobstructed urine flow is the main purpose of treatment. Drainage of urine through methods such as percutaneous nephrostomy under local anesthesia, insertion of double J tubes or ureteral stents, can assist in the removal of stones or buy time for future treatment of stones. It is difficult to assess the risks of anesthesia and surgery during pregnancy. General anesthesia in the first three months (early stages) of pregnancy can increase the likelihood of teratogenesis, but it is generally believed that this opportunity is very small. Advocating the retention of ureteral stents under local anesthesia, it is recommended to replace the stent tube once a month to prevent stones from forming and covering the stent tube. For patients with hydronephrosis and infected fluid accumulation, percutaneous nephrostomy under local anesthesia and ultrasound guidance before 22 weeks of pregnancy is the best choice. During drainage, bacterial culture can also be performed to guide treatment. Like indwelling ureteral stents, percutaneous nephrostomy can also avoid lithotripsy and lithotomy treatments that have a significant impact on pregnancy during pregnancy.
About one-third of patients experience recurrence due to failed conservative treatment, resulting in severe infections that ultimately require surgical treatment. Pregnancy complicated with stones should not be treated surgically because if complications occur during surgery, it is extremely difficult to manage. Generally, more traumatic treatment methods are not recommended, and conservative treatment is the preferred choice.
