Morgan K. et al., 2022: Urolithiasis in pregnancy: Advances in imaging modalities and evaluation of current trends in endourological approaches.

Morgan K, Rees CD, Shahait M, Craighead C, Connelly ZM, Ahmed ME, Khater N.
Department of Urology, Louisiana State University Health Sciences Center, Shreveport, USA.
Louisiana State University Health Sciences Center, School of Medicine Shreveport, LA, USA.
Department of Surgery, King Hussein Cancer Center, Amman, Jordan.
Department of Urology, Mayo Clinic, Rochester, USA.
Department of Urology, Louisiana State University Health Sciences Center, Shreveport, USA.

Abstract

Objective: Given the challenges involved in diagnosis and treatment of pregnant women with urolithiasis, we aim to review the imaging modalities and current endourological management of these patients.
Materials and methods: We performed a review of the available literature on urolithiasis in pregnancy. This included evaluation, diagnostic imaging, and therapeutic options. The databases we searched from included Google Scholar and PubMed. A total of 346 abstracts were screened. After our inclusion/exclusion criteria were met, we were left with 42 sources: 18 retrospective studies, 10 reviews/meta-analyses, 8 sets of guidelines, 5 randomized control trials, and 1 prospective cohort.
Results: We begin our review with the literature available on the safety and efficacy of imaging modalities in the surgical planning for urolithiasis in pregnant patients. This includes renal ultrasound, abdominal x-ray, computed tomography scan, and magnetic resonance imaging. While computed tomography may result in an added radiation exposure, with possible safety concerns, magnetic resonance imaging seems to be safer, however a less sensitive test. We next describe safety, efficacy, and outcomes of various surgical interventions for urolithiasis in pregnant patients. This encompasses ureteral stenting, percutaneous nephrostomy, ureteroscopy, extracorporeal shock wave lithotripsy, and percutaneous nephrolithotomy. Ureteroscopy is a safer approach, but percutaneous nephrolithotomy offers higher stone-free rates. Using an evidence-based approach, we propose an algorithm for management of the pregnant women with renal colic.
Conclusion: Management of the pregnant women with suspected urolithiasis is a unique challenge for healthcare providers. A multi-disciplinary approach should be taken to optimize outcomes through an evidence-based approach.
Actas Urol Esp (Engl Ed). 2022 Jun;46(5):259-267. doi: 10.1016/j.acuroe.2022.03.005. Epub 2022 May 9. PMID: 35551890 Review. English, Spanish.