Pregnancy and Urolithiasis Clinical Presentation
- Author: Robert O Wayment, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS more...
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).
Flank pain (89%) and hematuria (95%) are the most common symptoms of kidney stones ; however, these findings may also represent physiologic changes of pregnancy. Pregnancy-induced hydronephrosis can cause flank pain and even mimic renal colic, and microanatomic alterations in venous fragility of the collecting tubules may cause hematuria. Aside from its presentation in normal conditions, hematuria without discomfort is rare in the presence of a calculus.
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:
Pain radiating to the groin or labia
Less-common symptoms of urolithiasis include the following:
Lower abdominal pain
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
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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