Bjazevic J et al, 2018: Stones in pregnancy and pediatrics.
Bjazevic J, Razvi H.
Division of Urology, Department of Surgery, Western University, London, Canada.
Urinary stone disease is a highly prevalent condition affecting approximately 10% of the population, and has increased in incidence significantly over the past 20 years. Along with this, the rate of stone disease among women and children is also on the rise. The management of stone disease in specific populations, such as in children and during pregnancy can present unique challenges to the urologist. In both populations, a multi-disciplinary approach is strongly recommended given the complexities of the patients. Prompt and accurate diagnosis requires a high degree of suspicion and judicious use of diagnostic imaging given the higher risks of radiation exposure. In general, management proceeds from conservative to more invasive approaches and must be individualized to the patient with careful consideration of the potential adverse effects. However, innovations in endourologic equipment and techniques have allowed for the wider application of surgical stone treatment in these patients, and significant advancement in the field. This review covers the history and current advances in the diagnosis and management of stone disease in pregnant and pediatric populations. It is paramount for the urologist to understand the complexities of properly managing stones in these patients in order to maximize treatment efficacy, while minimizing complications and morbidity.
Asian J Urol. 2018 Oct;5(4):223-234. doi: 10.1016/j.ajur.2018.05.006. Epub 2018 Jun 5. Review. FREE ARTICLE
This article on stone treatment in pregnancy and paediatrics contains a lot of valuable information and despite the fact that SWL only briefly is touched; the text definitely is recommended for reading.
The principles for stone removal in children are summarized below and it is obvious that SWL still has a strong position.
Although SWL does not have a place in the management of stones that are diagnosed during pregnancy there are some other points that are important to know. What can be done and what cannot? I have a feeling that the knowledge of this problem is weak among urologists and that is reason why I have summarized below some important notations from the report. The possibilities and restrictions when stones are encountered during pregnancy often needs to be clarified for younger colleagues. :
During pregnancy the following principles are mandatory:
For stones diagnosed in trimesters:
I Expectation (70-80 % pass spontaneously)
For treatment of pain:
Contraindicated: NSAID and codeine
Allowed and recommended: Opioids
For MET: Alpha-receptor antagonists are considered safe
When a stent has been inserted:
Change every 4-6 weeks because of increased risk of incrustation!
Different reasons for detailed stone diagnosis during pregnancy are discussed in the article.
One question that always arises is how to establish the diagnosis.
Limits for radiological doses:
Trimester I 20 mGy Recommendation: US (or MRU if US is not diagnostic)
Trimester II 50 mGy Recommendation: low dose CT (