Presented by: Catarina Laranjo Tinoco
Hospital de Braga

Introduction

Renal colic is the most common non-obstetric cause of abdominal pain during pregnancy. Although urolithiasis is not more common in pregnant women, it is associated with a higher risk of complications. When invasive treatment is required, possible options are temporary drainage with ureteral stent (JJ) or percutaneous nephrostomy (PCN), or immediate definitive treatment with ureteroscopy (URS). Our goal was to evaluate the safety and efficacy of these techniques in the treatment of renal colic during pregnancy.

Materials

The review was elaborated according to the PRISMA checklist. PubMed, Embase, and Scopus database were browsed for articles containing data on the efficacy and complications of the 3 procedures in pregnant women. The quality of evidence and risk of bias of the selected articles was evaluated with the critical appraisal tools from the Critical Appraisal Skills Programme and the Institute of Health Economics

Results

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This review included 45 articles (cohort studies and case series) with a total of 3174 interventions in pregnant patients - 2491 URS, 715 JJ and 512 PCN. The mean age varied from 22 to 30.49 years and the renal colic was more common in the second trimester.

Regarding the treatment success, primary URS seems the more efficient than temporary drainage in which most patients need a second procedure after delivery. The stone-free rates reported for URS varied between 86 and 100%, and were not different from URS in non-pregnant patients, as showed by one comparative study.

The few comparative studies did not report statistically significant differences in post-operative complications between procedures. The most frequent complications of URS were lower urinary symptoms and urinary infections, with 13 cases of urosepsis (0.5%). Ureteral stenting complications were  bladder irritability in most patients, encrustation and stent migration. PCN complications were fever, bacteriuria, catheter obstruction and hematuria. Concerning obstetric complications, there were 184 cases of preterm labor with 23 premature births. A comparative study showed no statistically significant differences in preterm labors between URS and JJ patients, while another reported a higher rate of preterm induction of labor in JJ patients due to catheter intolerability.

Conclusion

Despite the lack of high-quality studies, the current evidence suggests that URS, JJ and PCN are all safe and effective in pregnant women that require invasive treatment. Primary ureteroscopy has a high efficacy rate, while the remaining options usually require a second procedure after delivery. 

Funding

None

Co-Authors

Maria João Braga,
School of Medicine, University of Minho

Andreia Cardoso,
Hospital de Braga

Ana Sofia Araújo,
Hospital de Braga

Mariana Capinha,
Hospital de Braga

Ricardo Rodrigues,
Hospital de Braga

Paulo Mota,
Hospital de Braga

Carlos Oliveira,
Hospital de Braga

João Pimentel Torres,
Hospital de Braga