Differences in management of pregnant women with obstructing infected ureteral stones: A population-based analysis

Factors predicting the need for surgical intervention for hydronephrosis during pregnancy: a systematic review of the literature

PURPOSE

Symptomatic hydronephrosis in pregnancy can cause both maternal and obstetric complications. In various studies, factors predicting the need for surgical intervention have been evaluated, however these factors have not been systematically assessed yet. This systematic review analyzes published studies about hydronephrosis during pregnancy and determines the predictive factors for the need for surgical intervention for hydronephrosis during pregnancy.

MATERIALS AND METHODS

A systematic review was conducted in January 2023 using the Medline, Web of Science and ScienceDirect/Scopus databases according to PRISMA guidelines. We searched these databases with the following search strategy: (intervention OR nephrostomy OR stent insertion) AND (pregnancy hydronephrosis).

RESULTS

The literature review revealed 2461 potentially eligible studies. After the screening, six studies were enrolled in this review. High neutrophil-to-lymphocyte ratio, high C-reactive protein level, high white blood cell count, high creatinine levels, fever, persistent pain for more than 4 days, presence of ureteral stones more than 8 mm, high grade hydronephrosis, high fetal body weight and high delta resistive index were reported to be related with the need for surgical intervention.

CONCLUSION

The rate of symptomatic hydronephrosis and requirement for surgical intervention is low during pregnancy. However, as symptomatic hydronephrosis may cause serious obstetric complications, it is important to know the parameters that can predict patients who may need surgical intervention. These results will assist gynecologists and urologists to stratify pregnant women for surgical intervention.

Contemporary Use of Computed Tomography (CT) Imaging in Suspected Urolithiasis in Pregnancy

PURPOSE OF REVIEW

We aimed to examine the role of low-dose CT (LDCT) in the diagnostic work-up for suspected urolithiasis in pregnancy. We reviewed contemporary urologic recommendations for CT in pregnancy, its utilization for suspected urolithiasis, and explored barriers to its use.

RECENT FINDINGS

National urologic guidelines and the American College of Obstetricians and Gynecologists recommend the judicious use of LDCT imaging in pregnancy when necessary. We noted inconsistencies in review article management pathways and recommendations for CT imaging for suspected urolithiasis in pregnancy. Overall CT utilization in pregnancy for suspected urolithiasis is low. Proposed barriers to LDCT use in pregnancy include fears of litigation and misperceptions of the harm of diagnostic radiation. Recent advancements in imaging technologies for urolithiasis in pregnancy are limited. More specific diagnostic pathway recommendations from national urologic guideline bodies for when to use LDCT to investigate renal colic in pregnancy may reduce diagnostic and intervention delays.