Presented by: Morgan Sturgis MD
Rush University Medical Center

Introduction

Kidney stones diagnosed during pregnancy are associated with an increased risk of maternal complications, but little is known about the risk of obstetric complications in patients conceiving shortly after nephrolithiasis treatment. We evaluated the association between upper tract stone (UTS) treatment and obstetric outcomes of pregnancies occurring within 2 years of treatment.

Materials

Women of childbearing age (18-52), diagnosed or treated for UTS in 2010 - 2021, who subsequently achieved pregnancy within 2 years of treatment, were identified from the PearlDiver-Mariner database, a nationwide all-payer claims database. UTS interventions and obstetric complications were identified using the appropriate  ICD 9/10 and CPT codes. UTS interventions were categorized as operative (URS, PCNL, SWL, open/laparoscopic/robotic, ancillary procedures (stent or nephrostomy tube) vs non-operative.  Associations between UTS intervention and obstetric complications were evaluated with uni- and multivariable analyses (MVA).

Results

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A total of 139,759 patients who achieved a pregnancy episode within 2 years of UTS diagnosis or treatment were identified. 113,604 (81.3%) were managed non-operatively. URS was the most common operation (18469/26155, 70.6%). Overall obstetric complication rate for those undergoing non-operative management was 19.3% vs 20.6% for operative management (p<0.0001). On MVA, operative management was associated with significantly greater odds of obstetric complications (OR 1.08; 95% CI 1.05-1.12), while Charlson comorbidity index, treatment year and treatment region were significant predictors. Compared with obstetric complication rate after non-operative management, complication rates following URS and ancillary procedures were significantly greater (p<0.0001 for each), while complication rates following each of the other surgical modalities were similar.

Conclusion

Our findings suggest that obstetric complication rates in women achieving pregnancy within 2 years of UTS diagnosis are significantly higher for those undergoing URS and ancillary procedures prior to pregnancy. Further studies to confirm these findings are needed.

Funding

No funding was utilized to execute this study. 

Co-Authors

Jamie Yoon, MD
Rush University Medical Center

Daniel Roadman, MD
Rush University Medical Center

Antonio Franco,
Rush University Medical Center

Riccardo Autorino, MD, PhD
Rush University Medical Center

Adan Becerra, PhD
Rush University Medical Center

Ephrem Olweny, MD
Rush University Medical Center