eMedicine Specialties > Urology > Stones

Pregnancy and Urolithiasis: Follow-up

Author: Robert O Wayment, MD, Resident Physician, Division of Urology, Southern Illinois University School of Medicine
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
Contributor Information and Disclosures

Updated: Mar 19, 2009

Follow-up

Deterrence/Prevention

See Diet.

Complications

  • Symptomatic urolithiasis does not appreciably worsen pregnancy outcome. Occurring in about 10-20% of patients, urinary tract infection is the most common nonobstetric complication of urolithiasis in pregnancy. Premature labor associated with renal colic is rare but can occur. In the past, spontaneous abortion has been associated with a history of urolithiasis but is extremely rare today.
  • Complications secondary to surgical interventions are more common in the pregnant population; however, they are becoming increasingly infrequent with increased experience and improved technology.
  • Physiologic changes of pregnancy are associated with an increase in perioperative risk. Complications of any surgical procedure may include the following:
    • Aspiration
    • Deep vein thrombosis
    • Pulmonary embolism
    • Premature delivery
  • Complications of internal stent placement may include the following:
    • Stent incrustation, which may be accelerated in pregnancy and require change every 3-4 weeks8
    • Infection
    • Sepsis
    • Stent migration
  • Complications of percutaneous nephrostomy may include the following:
    • Recurrent obstruction necessitating frequent flushing or replacement
    • Infection or sepsis secondary to tube obstruction
    • Fetal harm secondary to prolonged anesthesia requirements and ionizing radiation
    • Premature delivery42
    • Risk of bleeding caused by nephrostomy tube placement, tube dislodgement, and erosion
  • According to recent studies, complications of ureteroscopy and intracorporeal lithotripsy in pregnancy are rare in experienced hands.18,17,30 The risk of complications may be mildly increased because of the anatomic changes of pregnancy; however, the possible complications do not differ from those in the general population. These types of risks include the following:
    • Ureteral injury
    • Perforation
    • Subsequent stricture formation
  • Complications of open surgery include an increased risk of premature delivery. The rate of premature delivery after surgery is 6.5% during the first trimester, 8.6% during the second trimester, and 11.9% during the third trimester. Intrauterine growth restriction or premature birth (complication of receiving general anesthesia during pregnancy) is more likely.

Prognosis

  • Diagnosis and treatment of urolithiasis in pregnancy is complex. However, advances in technology and experience allow urologists to provide accurate evaluation and succeed with either temporizing or definitive treatments. These can be accomplished safely, with little risk to the mother or fetus. With prompt evaluation and expeditious treatment, the prognosis is excellent.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Spontaneous abortion
  • Premature labor
  • Urosepsis
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Jong M. Choe, MD, FACS, and previous coauthor Rajesh Prasad, MD, to the development and writing of this article.



More on Pregnancy and Urolithiasis

Overview: Pregnancy and Urolithiasis
Differential Diagnoses & Workup: Pregnancy and Urolithiasis
Treatment & Medication: Pregnancy and Urolithiasis
Follow-up: Pregnancy and Urolithiasis
Multimedia: Pregnancy and Urolithiasis
References
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Further Reading

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Keywords

urolithiasis in pregnancy, kidney stones, ureteral stones, bladder stones, urolithiasis, calculi, calculus, urosepsis, urinary tract infection, stone formation, uric acid stone disease, calcium stone disease, cystinuria, uric acid stone formation, calcium oxalate stone formation, calcium phosphate stone formation, crystalluria, struvite stones, renal calculi, nephrolithiasis, hypercalcemia, hypercalciuria, hydroureteronephrosis

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Contributor Information and Disclosures

Author

Robert O Wayment, MD, Resident Physician, Division of Urology, Southern Illinois University School of Medicine
Robert O Wayment, MD is a member of the following medical societies: American Medical Association and American Urological Association
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, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eleanor Lederer, MD, Consulting Staff, Louisville VA Hospital; Professor of Medicine, Director of Nephrology Training Program, Kidney Disease Program, University of Louisville School of Medicine; Director, Metabolic Stone Clinic
Eleanor Lederer, MD is a member of the following medical societies: American Association for the Advancement of Science, American Federation for Medical Research, American Society for Biochemistry and Molecular Biology, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, International Society of Nephrology, Kentucky Medical Association, National Kidney Foundation, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

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, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

 
 
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