Pregnancy and Urolithiasis Clinical Presentation

Updated: Jul 23, 2018
  • Author: Robert O Wayment, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
  • Print
Presentation

History

Urolithiasis in pregnancy poses 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 DDx). [13]

Flank pain (89%) and hematuria (95%) are the most common symptoms of kidney stones [8] ; 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. [11]

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

Next:

Physical Examination

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 possible signs and symptoms include the following:

  • Costovertebral angle tenderness
  • Generalized flank tenderness
  • Voluntary guarding of the abdominal musculature
Previous