Urinary Stone Disease during Pregnancy: One Problem, Two Patients

Abstract

Urolithiasis in pregnant women is a quite uncommon event: about one in 1500 pregnancies is complicated by urinary calculi and it occurs in 80–90% of the patients during the second or third trimester of pregnancy. Several factors may predispose stone formation in the upper urinary tract during pregnancy: the “physiological” hydronephrosis, the gestational hypercalciuria, and an elevation in both glomerular filtration rate and renal plasma flow, associated with an increase of creatinine clearance and higher renal filtration rate of sodium, calcium, and uric acid. Flank or abdominal pain is the most common symptom associated with evident or microscopic hematuria. Differential diagnosis of pain varies according to its location: it could be of gastrointestinal or gynecologic origin. Diagnosis is previously based on ultrasound evaluation. The use of radiation must be avoided during pregnancy, even if the risk of fetal injures depends on gestational age and radiation dosage. Most of the symptomatic ureteral stones affecting pregnant women pass spontaneously: therefore therapy could be conservative (hydration, analgesia, antibiotics, antiemetics) in the most of cases, although in the 15–30% of the cases it is necessary to adopt an active treatment, like percutaneous nephrostomy drainage, ureteral stent insertion or ureterorenoscopy.