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Pregnancy and Urolithiasis Clinical Presentation

  • Author: Robert O Wayment, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
 
Updated: Apr 17, 2015
 

History

Urolithiasis is derived from the Greek words ouron (urine) and lithos (stone). When in the setting of pregnancy, urolithiasis presents as a diagnostic challenge. Clinical manifestations of urolithiasis in pregnant patients often resemble signs and symptoms of pregnant patients without stones, not to mention many other sources of abdominal pathology (see Differentials).[13]

Flank pain (89%) and hematuria (95%) are the most common symptoms of kidney stones[7] ; however, these findings may also represent physiologic changes of pregnancy. Pregnancy-induced hydronephrosis can cause flank pain and even mimic renal colic,[14] and microanatomic alterations in venous fragility of the collecting tubules may cause hematuria.[15] Aside from its presentation in normal conditions, hematuria without discomfort is rare in the presence of a calculus.[5]

Alternatively, pregnant patients with ureteral stones may report pain in atypical locations or the pain of premature labor. Signs of premature labor, ectopic pregnancy, or complicated labor often mimic clinical symptoms of renal-ureteral calculi. Therefore, maintaining a high degree of suspicion in all pregnant women with abdominal or pelvic pain, hematuria (gross or microscopic), or unresolved urinary tract infections is imperative.

The most common symptoms of urolithiasis of pregnancy include the following:

  • Flank pain
  • Pain radiating to the groin or labia
  • Nausea
  • Dysuria
  • Gross hematuria

Less-common symptoms of urolithiasis include the following:

  • Lower abdominal pain
  • Fever/chills
  • Vomiting

Other important historical findings pertinent to urolithiasis include the following:

  • Recurrent or persistent urinary tract infection (especially during the current pregnancy)
  • History of previous calculi, either in a previous pregnancy or in the nonpregnant state
  • Prior urologic surgery
  • History of prior complicated pregnancy or premature delivery

Sites of urolithiasis may be localized based on the patient's description of pain, as follows:

  • Urolithiasis that obstructs at the ureteropelvic junction generally manifests as deep flank pain without radiation to the groin
  • Urolithiasis within the mid portion of the ureter can cause severe and intermittent pain, pain in the flank, and ipsilateral lower abdomen pain with radiation to the vulvar area
  • Urolithiasis in the distal ureter or ureterovesical junction may manifest as pain that radiates to the labia and irritative voiding symptoms such as urinary frequency and dysuria
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Physical

See the list below:

  • Patients with renal colic are often extremely restless, exhibiting active movement on presentation.
  • On inspection, the abdomen may be moderately distended, especially if the patient has coexisting ileus.
  • On palpation, the abdomen is soft and tender in the upper quadrant. This differs significantly from the motionless presentation and rigid abdomen of a patient with peritonitis.
  • On auscultation, bowel sounds do not provide helpful clues because they may range from hyperactive to markedly diminished because the patient may have concurrent ileus.
  • Other signs and symptoms include costovertebral angle tenderness, generalized flank tenderness, and voluntary guarding of the abdominal musculature.
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Contributor Information and Disclosures
Author

Robert O Wayment, MD Urologist, Ogden Clinic Urology

Robert O Wayment, MD is a member of the following medical societies: American Urological Association, Western Section of the American Urological Association, Utah Urological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, Society of Laparoendoscopic Surgeons, Society of University Urologists, Association of Military Osteopathic Physicians and Surgeons, American Urological Association, Endourological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eleanor Lederer, MD, FASN Professor of Medicine, Chief, Nephrology Division, Director, Nephrology Training Program, Director, Metabolic Stone Clinic, Kidney Disease Program, University of Louisville School of Medicine; Consulting Staff, Louisville Veterans Affairs Hospital

Eleanor Lederer, MD, FASN is a member of the following medical societies: American Association for the Advancement of Science, International Society of Nephrology, American Society for Biochemistry and Molecular Biology, American Federation for Medical Research, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, Kentucky Medical Association, National Kidney Foundation, Phi Beta Kappa

Disclosure: Received grant/research funds from Dept of Veterans Affairs for research; Received salary from American Society of Nephrology for asn council position; Received salary from University of Louisville for employment; Received salary from University of Louisville Physicians for employment; Received contract payment from American Physician Institute for Advanced Professional Studies, LLC for independent contractor; Received contract payment from Healthcare Quality Strategies, Inc for independent cont.

Chief Editor

Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, Society of Laparoendoscopic Surgeons, Society of University Urologists, Association of Military Osteopathic Physicians and Surgeons, American Urological Association, Endourological Society

Disclosure: Nothing to disclose.

Acknowledgements

Jeffrey B Garris, MD Chief, Assistant Professor, Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, Tulane University School of Medicine

Jeffrey B Garris, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, American Urological Association, Association of Professors of Gynecology and Obstetrics, Louisiana State Medical Society, Royal Society of Medicine, and Sigma Xi

Disclosure: Nothing to disclose.

Rajesh Prasad, MD Staff Physician, Department of Surgery, Division of Urology, University of Cincinnati Medical Center

Disclosure: Nothing to disclose.

References
  1. Folger GK. Pain and pregnancy; treatment of painful states complicating pregnancy, with particular emphasis on urinary calculi. Obstet Gynecol. 1955 Apr. 5(4):513-8. [Medline].

  2. Rodriguez PN, Klein AS. Management of urolithiasis during pregnancy. Surg Gynecol Obstet. 1988 Feb. 166(2):103-6. [Medline].

  3. Drago JR, Rohner TJ, Chez RA. Management of urinary calculi in pregnancy. Urology. 1982 Dec. 20(6):578-81. [Medline].

  4. Biyani CS, Joyce AD. Urolithiasis in pregnancy. II: management. BJU Int. 2002 May. 89(8):819-23. [Medline].

  5. Swanson SK, Heilman RL, Eversman WG. Urinary tract stones in pregnancy. Surg Clin North Am. 1995 Feb. 75(1):123-42. [Medline].

  6. Parulkar BG, Hopkins TB, Wollin MR, Howard PJ Jr, Lal A. Renal colic during pregnancy: a case for conservative treatment. J Urol. 1998 Feb. 159(2):365-8. [Medline].

  7. Stothers L, Lee LM. Renal colic in pregnancy. J Urol. 1992 Nov. 148(5):1383-7. [Medline].

  8. Denstedt JD, Razvi H. Management of urinary calculi during pregnancy. J Urol. 1992 Sep. 148(3 Pt 2):1072-4; discussion 1074-5. [Medline].

  9. Glowacki LS, Beecroft ML, Cook RJ, Pahl D, Churchill DN. The natural history of asymptomatic urolithiasis. J Urol. 1992 Feb. 147(2):319-21. [Medline].

  10. Gregory MC, Mansell MA. Pregnancy and cystinuria. Lancet. 1983 Nov 19. 2(8360):1158-60. [Medline].

  11. Riley JM, Dudley AG, Semins MJ. Nephrolithiasis and pregnancy: has the incidence been rising?. J Endourol. 2014 Mar. 28(3):383-6. [Medline].

  12. Burgess KL, Gettman MT, Rangel LJ, Krambeck AE. Diagnosis of urolithiasis and rate of spontaneous passage during pregnancy. J Urol. 2011 Dec. 186(6):2280-4. [Medline].

  13. Liu G, Wang J, Li J, Zheng J, Huang Z, Ye Z. Urolithiasis in pregnancy: survey in clinical epidemiology. J Huazhong Univ Sci Technolog Med Sci. 2011 Apr. 31(2):226-30. [Medline].

  14. Boridy IC, Maklad N, Sandler CM. Suspected urolithiasis in pregnant women: imaging algorithm and literature review. AJR Am J Roentgenol. 1996 Oct. 167(4):869-75. [Medline].

  15. Waltzer WC. The urinary tract in pregnancy. J Urol. 1981 Mar. 125(3):271-6. [Medline].

  16. Wolff JM, Jung PK, Adam G, Jakse G. Non-traumatic rupture of the urinary tract during pregnancy. Br J Urol. 1995 Nov. 76(5):645-8. [Medline].

  17. Loughlin KR, McAleer SJ. Management of Urological Problems in Pregnancy: A Rationale and Strategy. AUA Update Series. 2005. 24: Lesson 5:

  18. Katz DS, Klein MA, Ganson G, Hines JJ. Imaging of abdominal pain in pregnancy. Radiol Clin North Am. 2012 Jan. 50(1):149-71. [Medline].

  19. American College of Obstetricians and Gynecologists (ACOG). ACOG Committee Opinion. Number 299, September 2004 (replaces No. 158, September 1995). Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol. 2004 Sep. 104(3):647-51. [Medline].

  20. Srirangam SJ, Hickerton B, Van Cleynenbreugel B. Management of urinary calculi in pregnancy: a review. J Endourol. 2008 May. 22(5):867-75. [Medline].

  21. Lifshitz DA, Lingeman JE. Ureteroscopy as a first-line intervention for ureteral calculi in pregnancy. J Endourol. 2002 Feb. 16(1):19-22. [Medline].

  22. Lemos GC, El Hayek OR, Apezzato M. Rigid ureteroscopy for diagnosis and treatment of ureteral calculi during pregnancy. Int Braz J Urol. 2002 Jul-Aug. 28(4):311-5; discussion 316. [Medline].

  23. Ulvik NM, Bakke A, Høisaeter PA. Ureteroscopy in pregnancy. J Urol. 1995 Nov. 154(5):1660-3. [Medline].

  24. Laing FC, Benson CB, DiSalvo DN, Brown DL, Frates MC, Loughlin KR. Distal ureteral calculi: detection with vaginal US. Radiology. 1994 Aug. 192(2):545-8. [Medline].

  25. Loughlin KR, Ker LA. The current management of urolithiasis during pregnancy. Urol Clin North Am. 2002 Aug. 29(3):701-4. [Medline].

  26. Shokeir AA, Abdulmaaboud M. Resistive index in renal colic: a prospective study. BJU Int. 1999 Mar. 83(4):378-82. [Medline].

  27. White WM, Zite NB, Gash J, Waters WB, Thompson W, Klein FA. Low-dose computed tomography for the evaluation of flank pain in the pregnant population. J Endourol. 2007 Nov. 21(11):1255-60. [Medline].

  28. Rittenberg MH, Bagley DH. Ureteroscopic diagnosis and treatment of urinary calculi during pregnancy. Urology. 1988 Nov. 32(5):427-8. [Medline].

  29. Scarpa RM, De Lisa A, Usai E. Diagnosis and treatment of ureteral calculi during pregnancy with rigid ureteroscopes. J Urol. 1996 Mar. 155(3):875-7. [Medline].

  30. Houshiar AM, Ercole CJ. Urinary calculi during pregnancy. When are they cause for concern?. Postgrad Med. 1996 Oct. 100(4):131-8. [Medline].

  31. Barron WM. Medical evaluation of the pregnant patient requiring nonobstetric surgery. Clin Perinatol. 1985 Oct. 12(3):481-96. [Medline].

  32. Lipkin M, Shah O. The use of alpha-blockers for the treatment of nephrolithiasis. Rev Urol. 2006. 8 Suppl 4:S35-42. [Medline].

  33. Parsons JK, Hergan LA, Sakamoto K, Lakin C. Efficacy of alpha-blockers for the treatment of ureteral stones. J Urol. 2007 Mar. 177(3):983-7; discussion 987. [Medline].

  34. Watterson JD, Girvan AR, Beiko DT, Nott L, Wollin TA, Razvi H. Ureteroscopy and holmium:YAG laser lithotripsy: an emerging definitive management strategy for symptomatic ureteral calculi in pregnancy. Urology. 2002 Sep. 60(3):383-7. [Medline].

  35. Loughlin KR. Management of urologic problems during pregnancy. Urology. 1994 Aug. 44(2):159-69. [Medline].

  36. Evans HJ, Wollin TA. The management of urinary calculi in pregnancy. Curr Opin Urol. 2001 Jul. 11(4):379-84. [Medline].

  37. Kavoussi LR, Jackman SV, Bishoff JT. Re: Renal colic during pregnancy: a case for conservative treatment. J Urol. 1998 Sep. 160(3 Pt 1):837-8. [Medline].

  38. Kavoussi LR, Albala DM, Basler JW, Apte S, Clayman RV. Percutaneous management of urolithiasis during pregnancy. J Urol. 1992 Sep. 148(3 Pt 2):1069-71. [Medline].

  39. Rivera ME, McAlvany KL, Brinton TS, Gettman MT, Krambeck AE. Anesthetic exposure in the treatment of symptomatic urinary calculi in pregnant women. Urology. 2014 Dec. 84(6):1275-8. [Medline].

  40. Akpinar H, Tüfek I, Alici B, Kural AR. Ureteroscopy and holmium laser lithotripsy in pregnancy: stents must be used postoperatively. J Endourol. 2006 Feb. 20(2):107-10. [Medline].

  41. Streem SB. Contemporary clinical practice of shock wave lithotripsy: a reevaluation of contraindications. J Urol. 1997 Apr. 157(4):1197-203. [Medline].

  42. Kakkar VV. The current status of low-dose heparin in the prophylaxis of thrombophlebitis and pulmonary embolism. World J Surg. 1978 Jan. 2(1):3-18. [Medline].

  43. Pisegna JR. Switching between intravenous and oral pantoprazole. J Clin Gastroenterol. 2001 Jan. 32(1):27-32. [Medline].

  44. Li DK, Liu L, Odouli R. Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: population based cohort study. BMJ. 2003 Aug 16. 327(7411):368. [Medline].

  45. Boubred F, Vendemmia M, Garcia-Meric P, Buffat C, Millet V, Simeoni U. Effects of maternally administered drugs on the fetal and neonatal kidney. Drug Saf. 2006. 29(5):397-419. [Medline].

  46. Koren G, Florescu A, Costei AM, Boskovic R, Moretti ME. Nonsteroidal antiinflammatory drugs during third trimester and the risk of premature closure of the ductus arteriosus: a meta-analysis. Ann Pharmacother. 2006 May. 40(5):824-9. [Medline].

  47. Khoo L, Anson K, Patel U. Success and short-term complication rates of percutaneous nephrostomy during pregnancy. J Vasc Interv Radiol. 2004 Dec. 15(12):1469-73. [Medline].

  48. Armstrong SJ, Witcombe JB. Calcified hydronephrosis in pregnancy. Br J Radiol. 1991 Oct. 64(766):966-8. [Medline].

  49. Asgari MA, Safarinejad MR, Hosseini SY. Extracorporeal shock wave lithotripsy of renal calculi during early pregnancy. BJU Int. 1999 Oct. 84(6):615-7. [Medline].

  50. Butler EL, Cox SM, Eberts EG. Symptomatic nephrolithiasis complicating pregnancy. Obstet Gynecol. 2000 Nov. 96(5 Pt 1):753-6. [Medline].

  51. Cass AS, Smith CS, Gleich P. Management of urinary calculi in pregnancy. Urology. 1986 Nov. 28(5):370-2. [Medline].

  52. Fabrizio MD, Gray DS, Feld RI. Placement of ureteral stents in pregnancy using ultrasound guidance. Tech Urol. 1996 Fall. 2(3):121-5. [Medline].

  53. Fligelstone LJ, Datta SN, Evans C. Problematic renal calculi presenting during pregnancy. Ann R Coll Surg Engl. 1996 Mar. 78(2):142-5. [Medline].

  54. Gana BM, Taube M. Extracorporeal shock wave lithotripsy of renal calculi during early pregnancy. BJU Int. 2000 Feb. 85(3):384. [Medline].

  55. Gorton E, Whitfield HN. Renal calculi in pregnancy. Br J Urol. 1997 Jul. 80 Suppl 1:4-9. [Medline].

  56. Hendricks SK, Ross SO, Krieger JN. An algorithm for diagnosis and therapy of management and complications of urolithiasis during pregnancy. Surg Gynecol Obstet. 1991 Jan. 172(1):49-54. [Medline].

  57. Horowitz E, Schmidt JD. Renal calculi in pregnancy. Clin Obstet Gynecol. 1985 Jun. 28(2):324-38. [Medline].

  58. Kroovand RL. Stones in pregnancy and in children. J Urol. 1992 Sep. 148(3 Pt 2):1076-8. [Medline].

  59. Leslie S. Increasing urinary volume. Personal communication. Used with permission. 2001.

  60. Leslie S. The IRS plan for increasing urinary volume. Savitz G, Leslie S, eds. The Kidney Stones Handbook. 2nd ed. Roseville, Calif: Four Geez Press; 1999. 141-4.

  61. Powell CR, Stoller ML, Schwartz BF. Impact of body weight on urinary electrolytes in urinary stone formers. Urology. 2000 Jun. 55(6):825-30. [Medline].

  62. Rosenfeld JA. Renal disease and pregnancy. Am Fam Physician. 1989 Apr. 39(4):209-12. [Medline].

  63. Savitz G, Leslie S. Water, Water Everywhere. Savitz G, Leslie S, eds. The Kidney Stones Handbook. 2nd ed. Roseville, Calif: Four Geez Press; 1999. 131-40.

  64. Shokeir AA, Mahran MR, Abdulmaaboud M. Renal colic in pregnant women: role of renal resistive index. Urology. 2000 Mar. 55(3):344-7. [Medline].

  65. Thompson T, Kelly JD, Keane PF. Problematic renal calculi presenting during pregnancy. Ann R Coll Surg Engl. 1996 Jul. 78(4):399. [Medline].

  66. Wolf MC, Hollander JB, Salisz JA. A new technique for ureteral stent placement during pregnancy using endoluminal ultrasound. Surg Gynecol Obstet. 1992 Dec. 175(6):575-6. [Medline].

 
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The arrow in this intravenous pyelogram of a gravid female indicates a filling defect at the ureterovesical junction. This finding is most likely consistent with a ureteral stone (distal).
 
 
 
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