1
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Lyon M, Sun A, Shah A, Llarena N, Dempster C, Sivalingam S, Calle J, Gadani S, Zampini A, De S. Comparison of Radiation Exposure for Pregnant Patients Requiring Intervention for Suspected Obstructing Nephrolithiasis. Urology 2023; 182:61-66. [PMID: 37783398 DOI: 10.1016/j.urology.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/08/2023] [Accepted: 09/23/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE To identify the differences in radiation exposure per suspected stone episode between percutaneous nephrostomy tube (PCN), stent, and primary ureteroscopy (URS).The incidence of nephrolithiasis in pregnancy is low; however, repercussions for both mother and fetus can be significant. In cases of suspected obstructing nephrolithiasis, intervention may be required, including ureteral stent, PCN, or URS, with the potential for multiple subsequent procedures that often utilize fluoroscopy. METHODS Pregnant patients who required an intervention (stent, PCN, or URS) for suspected obstructing nephrolithiasis were retrospectively reviewed. The primary outcome was total fluoroscopy exposure per suspected stone episode. Secondary outcomes included fluoroscopic exposure per procedure and number of procedures required. RESULTS After excluding patients with renal anomalies and incomplete radiation data, 78 out of 100 patients were included in the analysis. Forty patients (51.3%) underwent initial stent placement, 22 (28.2%) underwent initial PCN placement, and 16 (20.5%) underwent primary URS. Total mean radiation exposure per stone episode was significantly higher in patients who underwent PCN, (286.9 mGy vs 3.7 mGy (stent) and 0.2 mGy (URS), P <.001). In addition, patients who underwent initial PCN placement had significantly more procedures (P <.001) and mean radiation exposure per procedure was higher (P <.001). More than 40% of PCNs experienced dysfunction, and mean duration between PCN exchanges was 16.5 days. CONCLUSION In pregnant patients with suspected obstructing nephrolithiasis requiring intervention, initial PCN placement was associated with a significantly higher number of procedures, radiation exposure per procedure, and total radiation exposure per suspected stone episode compared to stent and URS.
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Affiliation(s)
- Madison Lyon
- Cleveland Clinic Foundation, Glickman Urologic Institute, Cleveland, OH.
| | - Alec Sun
- Case Western Reserve University, Cleveland, OH
| | - Anup Shah
- Cleveland Clinic Foundation, Glickman Urologic Institute, Cleveland, OH
| | - Natalia Llarena
- Cleveland Clinic Foundation, Department of Obstetrics and Gynecology and Women's Health, Cleveland, OH
| | - Carrie Dempster
- Cleveland Clinic Foundation, Department of Obstetrics and Gynecology and Women's Health, Cleveland, OH
| | - Sri Sivalingam
- Cleveland Clinic Foundation, Glickman Urologic Institute, Cleveland, OH
| | - Juan Calle
- Cleveland Clinic Foundation, Glickman Urologic Institute, Cleveland, OH
| | - Sameer Gadani
- Cleveland Clinic Foundation, Department of Vascular and Interventional Radiology, Cleveland, OH
| | - Anna Zampini
- Cleveland Clinic Foundation, Glickman Urologic Institute, Cleveland, OH
| | - Smita De
- Cleveland Clinic Foundation, Glickman Urologic Institute, Cleveland, OH
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Meria P, Raynal G, Denis E, Plassais C, Cornet P, Gil-Jardiné C, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Management of symptomatic urinary stones. Prog Urol 2023; 33:791-811. [PMID: 37918980 DOI: 10.1016/j.purol.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
The acute situation, caused by an obstructive stone, is defined by a renal colic that may be uncomplicated, complicated, or at risk in specific conditions. Its management may be medical or require interventional treatment by extracorporeal shockwave lithotripsy, endoscopic removal, or ureteroscopy. METHODOLOGY: These recommendations were developed using two methods, the Clinical Practice Recommendations (CPR) and the ADAPTE method, in function of whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU Guidelines on urolithiasis. 2022] and whether they could be adapted to the French context.
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Affiliation(s)
- P Meria
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France
| | - G Raynal
- Clinique Métivet, department of urology, Saint-Maur-des-Fossés, France
| | - E Denis
- Centre hospitalier Saint-Joseph Saint-Luc, Lyon, France
| | - C Plassais
- Department of Urology, Hôpitaux Universitaires Pitié-Salpêtrière, Paris, France
| | - P Cornet
- Department of General Medicine, Sorbonne University, SFMG, Paris, France
| | - C Gil-Jardiné
- Pôle Urgences adultes - SAMU, Hôpital Pellegrin, CHU de Bordeaux, SFR-SIGU, Bordeaux, France; Inserm U1219, Bordeaux Population Health Research Centre, IETO Team, Bordeaux University, ISPED, Bordeaux, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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3
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Chan K, Shakir T, El-Taji O, Patel A, Bycroft J, Lim CP, Vasdev N. Management of urolithiasis in pregnancy. Curr Urol 2023; 17:1-6. [PMID: 37692143 PMCID: PMC10487296 DOI: 10.1097/cu9.0000000000000181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/04/2023] [Indexed: 02/17/2023] Open
Abstract
Urolithiasis is the most common cause of nonobstetric abdominal pain, resulting in 1.7 admissions per 1000 deliveries. Urolithiasis most commonly occurs in the second and third trimesters, with an incidence between 1:125 and 1:2000. Acute urinary system obstructions are challenging to manage in obstetric patients because they contribute to physiological and anatomical changes that result in pathological outcomes. The restricted use of computed tomography in diagnosing and managing urolithiasis is particularly challenging. In addition, a prompt diagnosis is required because the presence of renal calculi during pregnancy increases the risk of fulminating sepsis and preterm delivery. Affected pregnancies are conservatively managed; however, 1 in 4 requires surgical intervention. Indications for surgical interventions are complex and range from nephrostomy insertion to empirical stent placement or ureteroscopy. Therefore, a multidisciplinary approach is required to optimize patient care. The diagnosis and management of urolithiasis in pregnancy are complex. We reviewed the role, safety, advantages and disadvantages of diagnostic tests and treatment used to manage acute urinary obstructions in pregnancy.
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Affiliation(s)
- Kimberley Chan
- Urology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Taner Shakir
- Urology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Omar El-Taji
- Urology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Amit Patel
- Radiology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - John Bycroft
- Urology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Chou Phay Lim
- Gynaecology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Nikhil Vasdev
- Urology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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Radu VD, Vasilache IA, Costache RC, Scripcariu IS, Nemescu D, Carauleanu A, Nechifor V, Groza V, Onofrei P, Boiculese L, Socolov D. Pregnancy Outcomes in a Cohort of Patients Who Underwent Double-J Ureteric Stenting-A Single Center Experience. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:619. [PMID: 35630036 PMCID: PMC9147179 DOI: 10.3390/medicina58050619] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/23/2022] [Accepted: 04/27/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Minimally invasive procedures, such as double-J ureteric stenting, could be a promising therapeutic alternative to conservative management of obstructive urinary tract pathology. We aimed to evaluate the safety and effectiveness of double-J ureteric stenting in pregnant women with ureterohydronephrosis or urolithiasis, along with their infectious complications, and to assess the pregnancy outcomes of this cohort of patients in comparison with a control group. Materials and Methods: This observational retrospective study included 52 pregnant patients who underwent double-J ureteric stenting for urologic disorders in the Urology Department of ‘C.I. Parhon’ University Hospital, and who were followed up at a tertiary maternity hospital- ‘Cuza-Voda’, Iasi, Romania. The control group (63 patients) was randomly selected from the patient’s cohort who gave birth in the same time frame at the maternity hospital, without urinary pathology. Clinical, sonographic, and laboratory variables were examined. Descriptive statistics, non-parametric tests, and a one-to-one propensity score-matched analysis were used to analyze our data. Results: The univariate analysis indicated a significant statistical difference between the control group and the interventional group regarding maternal age (p = 0.018), previous maternal history of renal colic (p = 0.005) or nephrolithiasis (p = 0.002). After applying the propensity score-matched analysis, cesarean delivery rates (p < 0.001), preterm labour (p = 0.039), premature rupture of membranes (p = 0.026), preterm birth rates (p = 0.002), and post-partum UTI rates (p = 0.012) were significantly different between the control group and the matched treatment group. Ureterohydronephrosis, whether simple (n = 37; 71.2%) or infected (n = 13; 25%), was the main indication for double-J ureteric stenting. Complications such as pain (n = 21; 40.3%), stent migration (n = 3; 5.76%) or encrustation (n = 2; 3.84%), as well as reflux pyelonephritis (n = 2; 3.84%) and gross hematuria (n = 1; 1.92%) were recorded during follow-up. Conclusions: Our results show that double-J stenting is a safe and effective treatment option for pregnant patients with obstructive urological disorders.
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Affiliation(s)
- Viorel Dragos Radu
- Urology Department, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (V.D.R.); (R.-C.C.)
- Urology Department, ‘C.I. Parhon’ University Hospital, 700115 Iasi, Romania;
| | - Ingrid-Andrada Vasilache
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.-S.S.); (D.N.); (A.C.); (V.N.); (D.S.)
| | - Radu-Cristian Costache
- Urology Department, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (V.D.R.); (R.-C.C.)
- Urology Department, ‘C.I. Parhon’ University Hospital, 700115 Iasi, Romania;
| | - Ioana-Sadiye Scripcariu
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.-S.S.); (D.N.); (A.C.); (V.N.); (D.S.)
| | - Dragos Nemescu
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.-S.S.); (D.N.); (A.C.); (V.N.); (D.S.)
| | - Alexandru Carauleanu
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.-S.S.); (D.N.); (A.C.); (V.N.); (D.S.)
| | - Valentin Nechifor
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.-S.S.); (D.N.); (A.C.); (V.N.); (D.S.)
| | - Veaceslav Groza
- Urology Department, ‘C.I. Parhon’ University Hospital, 700115 Iasi, Romania;
| | - Pavel Onofrei
- Morphofunctional Sciences II Department, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Lucian Boiculese
- Medical Informatics and Biostatistics Department, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Demetra Socolov
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.-S.S.); (D.N.); (A.C.); (V.N.); (D.S.)
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5
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Keenan RA, Hegarty N, Davis N. Symptomatic hydronephrosis and ureteric calculi in pregnancy - a narrative review with a proposed management protocol. J Endourol 2022; 36:1099-1112. [DOI: 10.1089/end.2021.0876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Robert Anthony Keenan
- Beaumont Hospital, 57978, Transplant, Urology & Nephrology, Beaumont Hospital, Dublin, Ireland
| | - Nicholas Hegarty
- Mater Misericordiae University Hospital, 8881, Urology, Dublin, Ireland
| | - Niall Davis
- Royal College of Surgeons in Ireland, 8863, Dublin, Ireland
- Beaumont Hospital, 57978, Transplant, Urology & Nephrology, Dublin, Ireland
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6
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Ye Z, Mi Q, Huang R. Stent encrustation or fragmentation? A case report of post stent removal encrustation in postpartum woman and literature review. BMC Pregnancy Childbirth 2021; 21:789. [PMID: 34809587 PMCID: PMC8609729 DOI: 10.1186/s12884-021-04262-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 11/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ureteral stents are commonly used in the field of urology to relieve ureteral obstruction. However, complications relating to ureteral stent use, such as encrustation continue to occur, especially with prolonged indwell time. CASE PRESENTATION Here we present a 37-year-old postpartum woman with a foreign body in her bladder after removing a ureteral stent 1 month before. She insisted that the foreign body was the fragment of stent and asked for medical malpractice indemnity payments while the surgeon of her insisted that the stent was intact during the procedure. Finally, the foreign body was confirmed as an encrustation by cystoscopy and the patient received 10,000 yuan ($ 1500) as indemnity payments after encrustation removal. CONCLUSION In the absence of guidelines, stent indwelling time vary with centers' habits, stent materials and patient's education. Early detection of stent encrustation and timely removal of the encrusted stent are still the best way to avoid stent retention. Violent stent removal is of danger and not recommended in any case.
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Affiliation(s)
- Zhaohua Ye
- Department of Urology, Dongguan People's Hospital, Dongguan, 523000, China
| | - Qiwu Mi
- Department of Urology, Dongguan People's Hospital, Dongguan, 523000, China.
| | - Renzhao Huang
- Department of Urology, Dongguan People's Hospital, Dongguan, 523000, China
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Thongprayoon C, Vaughan LE, Chewcharat A, Kattah AG, Enders FT, Kumar R, Lieske JC, Pais VM, Garovic VD, Rule AD. Risk of Symptomatic Kidney Stones During and After Pregnancy. Am J Kidney Dis 2021; 78:409-417. [PMID: 33867205 PMCID: PMC8384636 DOI: 10.1053/j.ajkd.2021.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/05/2021] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE There are several well-known anatomical and physiological changes during pregnancy that could contribute to kidney stone formation, but evidence that they increase the risk of kidney stones during pregnancy is lacking. We determined whether there was an increased risk of a first-time symptomatic kidney stone during and after pregnancy. STUDY DESIGN A population-based matched case-control study. SETTING & PARTICIPANTS 945 female first-time symptomatic kidney stone formers aged 15-45 years and 1,890 age-matched female controls in Olmsted County, MN, from 1984-2012. The index date was the date of onset of a symptomatic kidney stone for both the case and her matched controls. EXPOSURE The primary exposure was pregnancy with assessment for variation in risk across different time intervals before, during, and after pregnancy. Medical records were manually reviewed to determine the conception and delivery dates for pregnancies. OUTCOME Medical record-validated first-time symptomatic kidney stone. ANALYTICAL APPROACH Conditional and unconditional multivariable logistic regression analysis. RESULTS Compared with nonpregnant women, the odds of a symptomatic kidney stone forming in women was similar in the first trimester (OR, 0.92; P=0.8), began to increase during the second trimester (OR, 2.00; P=0.007), further increased during the third trimester (OR, 2.69; P=0.001), peaked at 0 to 3 months after delivery (OR, 3.53; P<0.001), and returned to baseline by 1year after delivery. These associations persisted after adjustment for age and race or for diabetes mellitus, hypertension, and obesity. These results did not significantly differ by age, race, time period, or number of prior pregnancies. Having a prior pregnancy (delivery date>1year ago) was also associated with a first-time symptomatic kidney stone (OR, 1.27; P=0.01). LIMITATIONS Observational study design in a predominantly White population. The exact timing of stone formation cannot be determined. CONCLUSIONS Pregnancy increases the risk of a first-time symptomatic kidney stone. This risk peaks close to delivery and then improves by 1 year after delivery, though a modest risk of a kidney stone still exists beyond 1 year after delivery.
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Affiliation(s)
| | | | - Api Chewcharat
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Andrea G Kattah
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | - Rajiv Kumar
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Vernon M Pais
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Vesna D Garovic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; Department of Obstetrics, Mayo Clinic, Rochester, MN
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
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8
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Spradling K, Zhang CA, Pao AC, Liao JC, Leppert JT, Elliott CS, Conti SL. Risk of Postpartum Urinary Stone Disease in Women with History of Urinary Stone Disease During Pregnancy. J Endourol 2021; 36:138-142. [PMID: 34235965 DOI: 10.1089/end.2021.0223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine the risk of postpartum urinary stone disease in women with a history of stone disease during pregnancy. METHODS Using the Optum® de-identified Clinformatics® Datamart we identified pregnant women with urinary stone disease in the United States between January 2003 to December 2017 by standardized ICD-9, ICD-10, and CPT code criteria. We limited the cohort to include women without evidence of urinary stone disease prior to pregnancy. We abstracted patient demographic characteristics, clinical risk factors for stone disease, and data for urinary stone disease encounters and related procedures after pregnancy. Encounters occurring within 1 year of pregnancy were excluded. Cox proportional hazard models were used to analyze for significance. RESULTS We identified a total of 1,395,783 pregnant women with a median postpartum follow-up of 4.0 years, including 5,971 (0.4%) women diagnosed with a urinary stone during pregnancy. Of these, 736 (12.3%) had an additional urinary stone diagnosis claim after pregnancy, compared with 13,275 (0.95%) women without a history of stone disease during pregnancy (p < 0.0001). In multivariable proportional hazards models urinary stone disease during pregnancy (HR 12.8, 95% CI [11.8 - 13.8]) was independently associated with a higher hazard of urinary stone disease after pregnancy. CONCLUSION Women urinary stone disease during pregnancy were more likely to present with recurrent urinary stone disease after pregnancy. Given the 1 in 8 chance of needing further care, women with history of stone disease during pregnancy may benefit from risk counseling, surveillance, or secondary prevention efforts in the postpartum period.
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Affiliation(s)
- Kyle Spradling
- Stanford University School of Medicine, 10624, Urology, 300 Pasteur Drive, Stanford, California, United States, 94305;
| | | | - Alan C Pao
- Stanford University School of Medicine, 10624, Nephrology, 777 Welch Road, Suite DE, Palo Alto, California, United States, 94304;
| | - Joseph C Liao
- Stanford, Urology, 300 Pasteur Dr., S-287, Stanford, California, United States, 94305-5118;
| | - John T Leppert
- Stanford University School of Medicine, Urology, Room S-287, 300 Pasteur Drive, Stanford, California, United States, 94305;
| | - Christopher S Elliott
- Santa Clara Valley Medical Center, 14454, Urology, San Jose, California, United States;
| | - Simon L Conti
- Stanford Hospital and Clinics, 10623, Urology, 300 Pasteur Drive, Stanford, California, United States, 94305.,Stanford, Urology;
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9
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Zhou Q, Chen WQ, Xie XS, Xiang SL, Yang H, Chen JH. Maternal and neonatal outcomes of pregnancy complicated by urolithiasis: a systematic review and meta-analysis. J Nephrol 2021; 34:1569-1580. [PMID: 34173939 DOI: 10.1007/s40620-021-01093-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The effect of urolithiasis on pregnancy-related outcomes remains unknown. The aim of this study was to determine the risk of adverse maternal and neonatal outcomes. METHODS We searched PubMed, Embase, and the Cochrane Library through December 2020 for studies reporting on adverse maternal and neonatal outcomes in patients with urolithiasis. Risk ratios (ORs) with 95% confidence intervals (CIs) were calculated for these outcomes in pregnant mothers with urolithiasis and compared to healthy controls. RESULTS Eight studies comprising 26,577 mothers with urolithiasis were included in our analysis. Preterm birth (OR = 1.63; 95% CI 1.37-1.95, p < 0.001) or very preterm birth risk (OR = 1.49, 95% CI 1.06-2.11, p = 0.02) was more common in patients with urolithiasis compared to healthy controls. Mothers with urolithiasis had an increased incidence of preeclampsia (OR = 1.75, 95% CI 1.33-2.3, p < 0.001), hypertension (OR = 2.97, 95% CI 1.31-6.71, p = 0.009), caesarean section (OR 1.31, 95% CI 1.11-1.55, p = 0.001), and gestational diabetes mellitus (OR 1.84, 95% CI 1.37-2.46, p < 0.001). CONCLUSION Patients with urolithiasis may be at increased risk of developing adverse maternal or neonatal outcomes.
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Affiliation(s)
- Qin Zhou
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou, 31000, People's Republic of China.,Key Laboratory of Nephropathy, Hangzhou, People's Republic of China.,Kidney Disease Immunology Laboratory, The Third-Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, People's Republic of China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Hangzhou, People's Republic of China.,Institute of Nephropathy, Zhejiang University, Hangzhou, People's Republic of China
| | - Wen-Qing Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou, 31000, People's Republic of China.,Key Laboratory of Nephropathy, Hangzhou, People's Republic of China.,Kidney Disease Immunology Laboratory, The Third-Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, People's Republic of China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Hangzhou, People's Republic of China.,Institute of Nephropathy, Zhejiang University, Hangzhou, People's Republic of China
| | - Xi-Shao Xie
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou, 31000, People's Republic of China.,Key Laboratory of Nephropathy, Hangzhou, People's Republic of China.,Kidney Disease Immunology Laboratory, The Third-Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, People's Republic of China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Hangzhou, People's Republic of China.,Institute of Nephropathy, Zhejiang University, Hangzhou, People's Republic of China
| | - Shi-Long Xiang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou, 31000, People's Republic of China.,Key Laboratory of Nephropathy, Hangzhou, People's Republic of China.,Kidney Disease Immunology Laboratory, The Third-Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, People's Republic of China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Hangzhou, People's Republic of China.,Institute of Nephropathy, Zhejiang University, Hangzhou, People's Republic of China
| | - Hao Yang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou, 31000, People's Republic of China.,Key Laboratory of Nephropathy, Hangzhou, People's Republic of China.,Kidney Disease Immunology Laboratory, The Third-Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, People's Republic of China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Hangzhou, People's Republic of China.,Institute of Nephropathy, Zhejiang University, Hangzhou, People's Republic of China
| | - Jiang-Hua Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou, 31000, People's Republic of China. .,Key Laboratory of Nephropathy, Hangzhou, People's Republic of China. .,Kidney Disease Immunology Laboratory, The Third-Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, People's Republic of China. .,Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Hangzhou, People's Republic of China. .,Institute of Nephropathy, Zhejiang University, Hangzhou, People's Republic of China.
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10
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Sebastian N, Czuzoj-Shulman N, Spence AR, Abenhaim HA. Maternal and fetal outcomes of urolithiasis: A retrospective cohort study. J Gynecol Obstet Hum Reprod 2021; 50:102161. [PMID: 33984541 DOI: 10.1016/j.jogoh.2021.102161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/22/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Although urolithiasis is relatively common in the general population, there is limited information on this condition available in the pregnant population. The objectives of this study are to identify the incidence of urolithiasis in pregnancy, as well as to compare maternal and fetal outcomes associated with urolithiasis in pregnancy. METHODS Using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database from the United States, a population-based retrospective cohort study consisting of pregnant women who delivered between 1999 and 2015 was conducted. ICD-9-CM code 592.X was used to identify pregnant women with urolithiasis within the cohort, with pregnant women without urolithiasis forming the comparison group. Unconditional logistic regression models were used to estimate the associations between urolithiasis in pregnancy and maternal and neonatal outcomes, while adjusting for baseline maternal characteristics. RESULTS A cohort of 13,792,544 pregnant women was identified, of which 11,528 had a urolithiasis-related admission during pregnancy, for an overall incidence of 8.3 per 10,000 pregnancies. Women with urolithiasis had a greater risk of developing preeclampsia/eclampsia, OR 1.35(95% CI 1.24-1.47), gestational diabetes, 1.29(1.20-1.30), abruptio placenta, 1.41(1.22-1.64), placenta previa, 1.55(1.27-1.90), pyelonephritis, 88.87(81.69-96.69), venous thromboembolism, 1.65(1.23-2.22), and more likely to deliver by cesarean, 1.20(1.15-1.25). As well, maternal death was more common among these women, 2.85(1.07-7.60). Congenital anomalies, 2.84(2.43-3.31) and prematurity, 1.92(1.82-2.03) were more commonly found among babies born to women with urolithiasis. CONCLUSION Although the mechanism is unclear, women with urolithiasis in pregnancy have an increased risk of adverse pregnancy and newborn outcomes.
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Affiliation(s)
- Natasha Sebastian
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Nicholas Czuzoj-Shulman
- Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada
| | - Andrea R Spence
- Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada
| | - Haim Arie Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada.
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Kirubarajan A, Taheri C, Yau M, Aggarwal R, Lam ACL, Golda N, Buckley R. Incidence of kidney stones in pregnancy and associations with adverse obstetrical outcomes: a systematic review and meta-analysis of 4.7 million pregnancies. J Matern Fetal Neonatal Med 2021; 35:5282-5290. [PMID: 33541166 DOI: 10.1080/14767058.2021.1878141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Renal stones are a common cause of non-obstetrical abdominal pain in pregnant women. Though the management of renal stones in pregnancy is challenging, it remains unclear how the incidence of kidney stones may affect the course of pregnancy and delivery. OBJECTIVE To determine the incidence of renal stones in pregnancy and its impact on adverse obstetrical outcomes. DATA SOURCES We conducted a systematic literature search of three databases: Ovid MEDLINE, Ovid EMBASE, and EBSCO CINAHL Plus. After the selection of articles, an additional hand-search of their citations was completed to maximize sensitivity. Databases were examined from the last four decades (19 March 1970) up to the search date (19 March 2020). STUDY ELIGIBILITY CRITERIA Articles were excluded if they were not relevant to kidney stones or did not report outcomes related to pregnancy. Case reports, animal studies, and cadaveric studies were excluded. Conference abstracts, gray literature, and unpublished data were not eligible. STUDY APPRAISAL AND SYNTHESIS METHODS All screening, extraction, and synthesis were completed in duplicate with two independent reviewers. All outcomes reported in the included studies were systematically evaluated to determine suitability for meta-analysis. Random-effects models and sensitivity analyses were used to account for interstudy variation. Renal stone incidence rates were pooled to generate summary proportions. Risk of bias assessment was completed using the Risk of Bias Assessment tool for Non-randomized Studies. RESULTS Twenty-one studies were included through systematic review and approximately 4.7 million pregnancies across nine studies were included for meta-analysis. There are three major findings of this review regarding renal stone incidence in pregnancy and maternal, child, and birth-related outcomes associated with renal stones. First, we found pooled incidence of renal stones was 0.49%, or one case for every 204 pregnancies. Second, renal stones during pregnancy were significantly associated with the development of preeclampsia and urinary tract infection, as well as increased likelihood of low birth weight, preterm labor, and C-section deliveries. However, renal stones were not significantly associated with premature rupture of membranes or infant mortality. Third, there were limited obstetrical complications reported with either medical or surgical therapies although comparative outcomes were not provided in the majority of studies, precluding formal meta-analysis. CONCLUSIONS Although renal stones in pregnancy are relatively rare, there may be an associated risk of serious adverse obstetrical outcomes. However, further research is required to understand whether these obstetrical outcomes are causal or due to other confounders. Interdisciplinary care and pregnancy-specific counseling should be advised for pregnant women with kidney stones.
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Affiliation(s)
- Abirami Kirubarajan
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Cameron Taheri
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Matthew Yau
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | | | - Andrew C L Lam
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Nicole Golda
- Urology, North York General Hospital, Toronto, Canada
| | - Roger Buckley
- Urology, North York General Hospital, Toronto, Canada
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12
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White J, Ory J, Lantz Powers AG, Ordon M, Kroft J, Cox A. Urological issues in pregnancy: A review for urologists. Can Urol Assoc J 2020; 14:352-357. [PMID: 32432535 PMCID: PMC7716830 DOI: 10.5489/cuaj.6526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Urological issues in the pregnant patient present a unique clinical dilemma. These patients may be challenging to treat due to risks associated with medications and surgical procedures. This review aims to provide an update on the physiological changes and surgical risks in pregnancy. In addition, we review the approach for management of urolithiasis and urinary tract infections in pregnancy. Lastly, we highlight the importance of a multidisciplinary approach to placenta percreta, a condition not commonly addressed in urological education.
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Affiliation(s)
- Joshua White
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Jesse Ory
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | | | - Michael Ordon
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Jamie Kroft
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
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13
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Dai JC, Nicholson TM, Chang HC, Desai AC, Sweet RM, Harper JD, Sorensen MD. Nephrolithiasis in Pregnancy: Treating for Two. Urology 2020; 151:44-53. [PMID: 32866511 DOI: 10.1016/j.urology.2020.06.097] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/12/2020] [Accepted: 06/28/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To review the literature regarding the epidemiology of stone disease and develop a management algorithm based on current evidence and societal guidelines. METHODS A structured literature review was performed to determine highest quality of evidence guiding care for pregnant patients with symptomatic nephrolithiasis. PUBMED and EMBASE databases were searched using terms "pregnancy," "nephrolithiasis," or "pregnancy" and "renal colic" alone and in combination with "stone", "kidney stone," "ultrasound," "MRI," "CT," "percutaneous nephrostomy," "ureteral stent," or "ureteroscopy." All English-language abstracts were reviewed for relevance and full-length articles were reviewed for content. Articles published prior to 1990 were excluded, and priority for inclusion was given to multi-institutional studies and larger institutional studies, reflecting the highest level of current available evidence and most contemporaneous practice patterns. RESULTS Symptomatic nephrolithiasis affects less than 1% of pregnancies but poses unique diagnostic challenges due to the physiologic changes of pregnancy and risks of ionizing radiation exposure to the fetus. Ultrasound remains the imaging modality of choice. Most patients may be managed non-operatively, but drainage with percutaneous nephrostomy or ureteral stent may be performed if warranted. Growing evidence also supports the safety and efficacy of definitive stone treatment. CONCLUSIONS Though rare, symptomatic nephrolithiasis poses significant clinical challenges due to the need to minimize risk for both mother and fetus with diagnostic and therapeutic interventions. A multi-disciplinary approach is paramount, as is shared decision making with the patient at each step of care.
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Affiliation(s)
- Jessica C Dai
- Department of Urology, University of Washington, Seattle, WA.
| | | | - Helena C Chang
- Department of Urology, Kaiser Permanente Santa Clara Medical Center, Santa Clara CA
| | - Alana C Desai
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Robert M Sweet
- Department of Urology, University of Washington, Seattle, WA
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