Management of HYDRONEPHROSIS during PREGNANCY URETERIC STONES DURING PREGNANCY with safe material and fetal outcome. She presented her 10 years experience with such cases at international Urogynecology conference held at IRELAND in 2013

1. DR. K. LALITHA
M.D., M.Ch.(UROLOGY)
UROLOGIST & GYNECOLOGIST
MBBS – KMC, WARANGAL-1988
MD(OBG)-PGIMER(CHANDIGARH)-1991
MCh(UROLOGY)-OMC(HYD)-1997
AREA OF INTEREST-FEMALE UROLOGY
UROGYNECOLOGY

2. MANAGEMENT OF URETERIC
STONES DURING PREGNANCY
DR.LALITHA
UROLOGIST &UROGYNECOLOGIST
YASHODA HOSPITAL,SOMAJIGUDA

3. INTRODUCTION
• RENAL COLIC IS THE MOST COMMON NON-
OBSTETRIC INDICATION FOR HOSPITALIZATION
• UROLITHIASIS INCREASES THE RISK OF
PRETERM LABOUR FROM 3% TO 7%
• UROLITHIASIS AFFECTS 1 IN 200 TO 1IN 1500

4. INTRODUCTION
• CONSERVATIVE TREATMENT IS THE MAINSTAY
• 15% REQUIRE UROLOGICAL INTERVENTION
• DOUBLE J STENTING WAS THE STANDARD
FORM OF TREATMENT

5. AIM
• TO STUDY THE SAFETY AND FEASIBILITY OF
URETEROSCOPIC LITHOTRIPSY DURING
PREGNANCY
• TO DISCUSS THE DIAGNOSTIC &
THERAPEUTIC CHALLENGES

6. MATERIAL & METHODS
A RETROSPECTIVE STUDY OF 220 PREGNANT
WOMEN WITH UROLITHIASIS TREATED BY US
BETWEEN FEB 2002 TO FEB 2012
40 WOMEN REQUIRED ACTIVE
ENDOUROLOGICAL INTERVENTION.

7. DIAGNOSTIC TOOLS
• ULTRASOUND KUB - DD PHYSIOLOGICAL
HYDRONEPHROSIS
• MR UROGRAPHY
• IVP / CT ARE CONTRAINDICATED

8. INDICATIONS FOR INTERVENTION
• RENAL COLIC
• INCREASING HYDRONEPHROSIS
• UROSEPSIS
• OLIGURIA / ANURIA

11. Lower ureteric stone with hydroureter

13. RESULTS -TYPE OF INTERVENTION
• URETEROSCOPIC STONE REMOVAL FOR
DISTAL URETERIC STONES - 18
• DOUBLE J STENTING FOR WOMEN WITH
PROXIMAL URETERIC STONES - 22

14. RESULTS
• 18 - DISTAL URETERIC STONES
• 3 STONES > 1 CM
• 1 CASE OF TWIN PREGNANCY
• 1 - BICORNUATE UTERUS

15. RESULTS
COMPLICATIONS
UROLOGICAL - UROSEPSIS - NIL
URETERIC PERFORATION – NIL
OBSTETRIC - PRETERM LABOUR - 1

16. DISCUSSION
• URETERIC STONE DURING PREGNANCY MAY
SOMETIMES REQUIRE UROLOGICAL
INTERVENTION
• DIAGNOSTIC DILEMMA DUE TO
PHYSIOLOGICAL HYDRONEPHROSIS DUE TO
INABILITY TO USE X-RAYS

17. DISCUSSION
• THERAPEUTIC CHALLENGES
• ESWL CONTRAINDICATED
• INTRA-OP C-ARM CANNOT BE USED
• DIFFICULT TO ACCESS PROXIMAL URETER
• RISK OF ANAESTHESIA TO THE FETUS

18. DISCUSSION
• DOUBLE J STENTING - STANDARD APPROACH
• RECENT ADVANCES IN ENDOUROLOGY MADE
URETEROSCOPIC LITHOTRIPSY A SAFER
ALTERNATIVE

19. ADVANTAGES
• SECOND PROCEDURE AVOIDED
• STENT RELATED COMPLICATIONS AVOIDED
• LUTS
• HEMATURIA
• ENCRUSTATIONS

20. CONCLUSION
• URETEROSCOPIC LITHOTRIPSY DURING
PREGNANCY IS FEASIBLE AND SAFE IN A
SELECT GROUP OF PATIENTS IN A WELL
EQUIPPED ENDOUROLOGY UNIT
• A TEAM OF EXPERTS IN
UROLOGY, OBSTETRICS,RADIOLOGY &
ANAESTHESIOLOGY IS ESSENTIAL FOR
OPTIMAL OUTCOME.