Pregnancy and Urolithiasis Guidelines

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

Guidelines Summary

Diagnosis

The European Association of Urology (EAU) guidelines recommend ultrasonography (US) as the treatment of choice for the diagnosis of urolithiasis during pregnancy. However, the guidelines note that normal physiologic changes in pregnancy can mimic ureteral obstruction and the role of US is limited in acute obstruction because it cannot properly differentiate causes of dilation. Magnetic resonance imaging (MRI)  is recommended as a second-line imaging study, but use of low-dose computed tomography (CT) is restricted to selected cases. [28]

The American College of Obstetricians and Gynecologists (ACOG) makes the following general recommendations regarding diagnostic imaging procedures during pregnancy [19] :

  • Ultrasonography and MRI are the imaging techniques of choice, but should be used prudently and only when use is expected to answer a relevant clinical question or otherwise provide medical benefit to the patient.
  • With few exceptions, radiation exposure through radiography, CT scan, or nuclear medicine imaging techniques is at a dose much lower than the exposure associated with fetal harm. If these techniques are necessary, they should not be withheld.
  • The use of gadolinium contrast with MRI should be limited; it may be used as a contrast agent only if it significantly improves diagnostic performance and is expected to improve fetal or maternal outcome.

​Treatment

Both the American Urological Association (AUA) and the European Association of Urology (EAU) have released guidelines for the treatment of urolithiasis that include specific recommendations for management during pregnancy. [20, 49, 50]

The AUA recommends that treatment be coordinated with the obstetrician. First-line therapy for patients with well-controlled symptoms is observation. Ureteroscopy (URS) should be offered to patients in whom observation fails. Ureteral stent and nephrostomy tube are alternative treatment options, with frequent stent or tube changes usually being necessary. [49, 50]

The EAU guidelines concur that conservative management should be first-line treatment for all noncomplicated cases of urolithiasis in pregnancy. (except those that have clinical indications for intervention). If spontaneous passage does not occur or if complications develop, placement of a ureteral stent or a percutaneous nephrostomy tube is recommended.  Regular follow-up until final stone removal is needed due to the higher encrustation tendency of stents during pregnancy. URS is an alternative for patients with who have poor tolerance for those temporary therapies. [20]