Abstract
Renal colic is the most frequent non-obstetric cause for abdominal pain and subsequent hospitalization during pregnancy. Intervention is necessary in patients who do not respond to conservative treatment. Ultrasound (US) is widely used as the first-line diagnostic test in pregnant women with nephrolithiasis, despite it is highly nonspecific and may be unable to differentiate between ureteral obstruction secondary to calculi and physiologic hydronephrosis. Magnetic resonance imaging (MRI) should be considered as a second-line test, when US fails to establish a diagnosis and there are continued symptoms despite conservative management. Moreover, MRI is able to differentiate physiologic from pathologic dilatation. In fact in the cases of obstruction secondary to calculi, there is renal enlargement and perinephric edema, not seen with physiological dilatation. In the latter, there is smooth tapering of the middle third of the ureter because of the mass effect between the uterus and adjacent retroperitoneal musculature. When the stone is lodged in the lower ureter, a standing column of dilated ureter is seen below this physiological constriction. MRI is also helpful in demonstrating complications such as pyelonephritis. In the unresolved cases, Computed tomography remains a reliable technique for depicting obstructing urinary tract calculi in pregnant women, but it involves ionizing radiation. Nephrolithiasis during pregnancy requires a collaboration between urologists, obstetricians, and radiologists.
Similar content being viewed by others
References
Srirangam SJ, Hickerton B, Van Cleynenbreugel B (2008) Management of urinary calculi in pregnancy: a review. J Endourol 22(5):867–875
Ross AE, Handa S, Lingeman JE, Matlaga BR (2008) Kidney stones during pregnancy: an investigation into stone composition. Urol Res 36(2):99–102
Semins MJ, Matlaga BR (2010) Management of stone disease in pregnancy. Curr Opin Urol 20(2):174–177
Charalambous S, Fotas A, Rizk DE (2009) Urolithiasis in pregnancy. Int Urogynecol J Pelvic Floor Dysfunct 9:1133–1136
Wayment RO, Schwartz BF. Pregnancy and urolithiasis. http://emedicine.medscape.com/article/455830-overview. Accessed 19 Mar 2009
Travassos M, Amselem I, Filho NS, et al. (2009) Ureteroscopy in pregnant women for ureteral stone. J Endourol 23(3):405–407
McAleer SJ, Loughlin KR (2004) Nephrolithiasis and pregnancy. Curr Opin Urol 14(2):123–127
Loughlin KR (1994) Management of urologic problems during pregnancy. Urology 44(2):159–169
Birchard KR, et al. (2005) MRI of acute abdominal and pelvic pain in pregnant patients. AJR 184:452–458
Oto A, Ernst RD, Ghulmiyyah LM, et al. (2009) MR imaging in the triage of pregnant patients with acute abdominal and pelvic pain. Abdom Imaging 34:243–250
Masselli G, Brunelli R, Casciani E, et al. (2011) Acute abdominal and pelvic pain in pregnancy: MR imaging as a valuable adjunct to ultrasound? Abdom Imaging 36(5):596–603
Masselli G, Brunelli R, Parasassi T, Perrone G, Gualdi G (2011) Magnetic resonance imaging of clinically stable late pregnancy bleeding: beyond ultrasound. Eur Radiol 21(9):1841–1849
Biyani CS, Joyce AD (2002) Urolithiasis in pregnancy. II: management. BJU Int 89:819–823
Denstedt JD, Razvi H (1992) Management of urinary calculi during pregnancy. J Urol 148(3Pt2):1072–1074; discussion 1074–1075
Cheriachan D, Arianayagam M, Rashid P (2008) Symptomatic urinary stone disease in pregnancy. Aust N Z J Obstet Gynaecol 48(1):34–39
McAleer SJ, Loughlin KR (2004) Nephrolithiasis and pregnancy. Curr Opin Urol 14:123–127
Lifshitz DA, Lingeman JE (2002) Ureteroscopy as a first line intervention for ureteral calculi in pregnancy. J Endourol 16:19
Akpinar H, Tüfek I, Alici B, et al. (2006) Ureteroscopy and holmium laser lithotripsy in pregnancy: stents must be used postoperatively. J Endourol 20:107–110
Rana AM, Aquil S, Khawaja AM (2009) Semirigid ureteroscopy and pneumatic lithotripsy as definitive management of obstructive ureteral calculi during pregnancy. Urology 73:964–967
Semins MJ, Trock BJ, Matlaga BR (2009) The safety of ureteroscopy during pregnancy: a systematic review and meta-analysis. J Urol 181:139–143
Yamazaki JN, Schull WJ (1990) Perinatal loss and neurological abnormalities among children of the atomic bomb: Nagasaki and Hiroshima revisited, 1949 to 1989. J Am Med Assoc 264:605–609
Castronovo FP (1999) Teratogen update: radiation and Chernobyl. Teratology 60:100–106
Brent RL (1989) The effect of embryonic and fetal exposure to X-ray, microwaves, and ultrasound: counseling the pregnant and nonpregnant patient about these risks. Semin Oncol 16:347–368
Wagner LK, Lester RG, Saldana LR (1997) Exposure of the pregnant patient to diagnostic radiations: a guide to medical management, 2nd edn. Madison: Medical Physics
Barnett SB (2002) Routine ultrasound scanning in first trimester: what are the risks? Semin Ultrasound CT MR 23:387–391
Abramowicz JS, Kossoff G, Marsal K, Ter Haar G (2003) Safety statement, 2000 (reconfirmed 2003). International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). Ultrasound Obstet Gynecol 21:100
MacNeily AE, Goldenberg SL, Allen GJ, Ajzen SA, Cooperberg PL (1991) Sonographic visualization of the ureter in pregnancy. J Urol 146:298–301
Laing FC, Benson CB, DiSalvo DN, et al. (1994) Distal ureteral calculi: detection with vaginal US. Radiology 192:545–548
Shokeir AA, Mahran MR, Abdulmaaboud M (2000) Renal colic in pregnant women: role of renal resistive index. Urology 55:344–347
Shokeir AA, Abdulmaaboud M (1999) Resistive index in renal colic: a prospective study. BJU Int 83:378–382
Clements H, Duncan KR, Fielding K, et al. (2000) Infants exposed to MRI in utero have a normal paediatric assessment at 9 months of age. Br J Radiol 73:190–194
Kok RD, de Vries MM, Heerschap A, et al. (2004) Absence of harmful effects of magnetic resonance exposure at 1.5 T in utero during the third trimester of pregnancy: a follow-up study. Magn Reson Imaging 22:851–854
Kanal E, Barkovich AJ, Bell C, et al. (2007) ACR guidance document for safe MR practices. AJR Am J Roentgenol 188:1447–1474
Spencer JA, Chahal R, Kelly A, et al. (2004) Evaluation of painful hydronephrosis in pregnancy: magnetic resonance urographic patterns in physiological dilatation versus calculous obstruction. J Urol 171:256–260
Regan F, Kuszyk B, Bohlman ME, et al. (2005) Acute ureteric calculus obstruction: unenhanced spiral CT versus HASTE MR urography and abdominal radiograph. Br J Radiol 78:506–511
Mullins JK, et al. (2012) Half Fourier single-shot turbo spin-echo magnetic resonance urography for the evaluation of suspected renal colic in pregnancy. Urology 79:1252–1255
White WM, Zite NB, Gash J, et al. (2007) Low-dose computed tomography for the evaluation of flank pain in the pregnant population. J Endourol 21:1255–1260
White WM, Zite NB, Gash J, et al. (2008) Low-dose computed tomography for the evaluation of flank pain in the pregnant population. Aust N Z J Obstet Gynaecol 48:34–39
Hurwitz LM, Yoshizumi T, Reiman RE, et al. (2006) Radiation dose to the fetus from body MDCT during early gestation. AJR Am J Roentgenol 186:871–876
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Masselli, G., Derme, M., Laghi, F. et al. Imaging of stone disease in pregnancy. Abdom Imaging 38, 1409–1414 (2013). https://doi.org/10.1007/s00261-013-0019-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-013-0019-3