Treatment of renal colic with double-J stent during pregnancy: a report of 25 cases

Abstract

There is no consensus on the treatment of renal colic, a hazardous condition for both pregnant women and their fetus during pregnancy. The present study was to evaluate the therapeutic safety and efficacy of double-J stent. Twenty-five pregnant women were admitted into our hospital for renal colic between January 2008 and June 2009. The mean age was (28.3 ± 4.9) years old. And the mean gestational week was (20.1 ± 6.9) weeks. The diagnostic and therapeutic procedures were as follows: (1) Upon admission, routine urine and blood tests, chemistry panel and ultrasonography were performed. (2) Analgesics or antispasticity drugs were dispended to the patients, such as progesterone. (3) Magnesium sulfate was used for anti-inflammation. (4) If renal colic was not relieved, a double-J stent was inserted into the ureter via cystoscopy. At pre-, intra- and post-operation, an obstetrician monitored the fetal heart and uterine contraction. (5) Ultrasonography was conducted to check the location of double-J stent. (6) After delivery, the women underwent ESWL (extracorporeal shock wave lithotripsy) and then the double-J stent was extracted. Five (20%, 5/25) patients had a positive previous history: three for renal calculus (n = 3), solitary kidney (n = 1) and reimplantation of ureter (n = 1). Only one patient run a high fever of 40°C. Most patients (84%) had a positive percussion over renal regions. Only 6 patients (24%, 6/25) were found to have a great quantity of red blood cells in urine. Half of the patients showed 10 - 20 white blood cells (WBC) per high power field in urine. Fifteen patients (60%, 15/25) had an elevated count of WBC in routine blood test. Only one patient was with elevated serum creatinine because of her solitary kidney. The calcium level decreased in 8 patients (32%, 8/25). All patients suffered hydronephrosis while 18 patients (72%, 18/25) were not found with calculus in ureters or kidneys. Pain of six patients (24%, 6/25) was relieved after the dosing of analgesics. Eighteen patients (72%, 18/25) underwent double-J stent insertion and 1 patient (4%, 1/25) received percutaneous renal puncture. Then pain was relieved and hydronephrosis vanished. After delivery, calculi were treated properly and then the double-J stent were extracted. Iconography showed no residual calculi. For pregnant women with renal colic, retrograde intra-ureteral cannula of double-J stent is both safe and effective. It should be recommended for all renal colic women during pregnancy with or without calculus after the ineffective dosing of analgesics.