It is considered natural to have a certain amount of swelling in the kidneys even if there is no stone in pregnancy. This is due to the fact that the canals that transmit urine from the kidney to the urinary bladder due to the pregnancy of the womb which has been enlarged with pregnancy, as well as the hormonal changes during pregnancy, loosen the urine channels and contribute to the relative swelling. This swelling, which is accepted as natural in the kidneys, starts at 6 to 10 weeks of pregnancy and can cause swelling until 6 weeks after birth. Such swelling does not cause pain, but swelling of the kidneys causing unilateral pain should cause suspicion of stone.
It is important that pregnant women with pain should be evaluated for stone and the diagnosis should not be omitted, as a kidney stone whose diagnosis is missed may cause premature birth, preeclampsia or isolated high blood pressure, except for damaging the kidneys in pregnant women.
Why is it difficult to diagnose kidney stones in pregnancy?
The diagnosis of stone in pregnancy is not as easy as in nonpregnant patients. While the side pain, nausea, vomiting and frequent urination of the kidney stone are seen without any stone disease in pregnant women, stone pain may be felt at different points from the classical position of waist and groin in pregnant women and it may make it difficult for the doctor to interpret the pain.
What methods can be diagnosed during pregnancy?
In addition to the difficulty in physical examination, imaging methods that can be used during the diagnosis of stone in pregnant women are limited. Especially the use of imaging methods with radiation such as computed tomography (CT), intravenous pyelography (IVP) and fluoroscopy over a certain dose may adversely affect the physical and mental development of the baby in the mother’s womb as well as increase the risk of cancer. It is appropriate to use these radiation-containing methods in such cases as being too complex to be diagnosed by other methods and in situations that threaten the life of the mother or the baby.
In contrast, ultrasound, which is a radiation-free method, is safe for the baby in the womb, and can therefore be used as a first-choice imaging method in pregnant women with suspected stone. The ability to diagnose ultrasound is significantly reduced when the kidneys develop naturally during pregnancy, or which cause new obstruction that cannot cause swelling.
Magnetic resonance imaging (MRI) is an imaging modality that can be used safely in pregnant women. With this method, changes in the kidneys and urine channels can be clearly visualized. The problem with MRI is that the stone itself does not give a clear image on MRI. Therefore, MR can clearly show that there is an obstruction in the urinary tract, while it cannot give clear information about the cause of stenosis.
As a result, ultrasound is the first choice in suspected kidney stone, while MR, CT and IVP have limited use in undiagnosed cases.
How is kidney stone treatment done in pregnant women?
The general condition of the patient, the duration of pregnancy, the size and location of the stone in the diagnosed stones determine the general outline of the treatment.
First of all, it should be known that approximately 70% of the stones fall spontaneously when followed by oral medication. Therefore, all pregnant women whose pain and nausea can be controlled by oral medications and whose renal swelling does not progress at a critical level are followed. In patients whose general condition worsens and whose pain and nausea cannot be controlled by oral medications, additional treatment methods should be considered. The main aim of the treatment is to restore the urine flow without any harm to the expectant mother and the unborn baby, and to control the pain and nausea.
Traditionally, the first treatment in this direction was ureteral stenting. In this procedure, a catheter, a rubber tube is inserted between the kidney and the bladder, passing through the stone to the channel, which is clogged with stone. This rubber tube remains in the patient during pregnancy and allows many pregnants to be postponed until the final treatment after pregnancy. In some pregnant women, this inserted tube is insufficient to cut stone pain, it causes sensitivity and pain in the bladder, and decreases the quality of life of pregnant women with frequent need for toilet. ESWL, which is a stone breaking method with external sound waves, is inconvenient for pregnant women.
These patients are no longer condemned to ureteral catheters in parallel with advances in endoscopic instruments and laser technology. At the end of the ureteroscope with light and camera with a special device called ureters entering the urine through the urinary tract under the direct direction of the stone is encountered and when the stone is disintegrated. These devices, called ureteroscopes, are rigid in general use and metal models that allow only 5-7 degrees of bending. However, in pregnant women, especially when the uterus is more than a certain size during advanced weeks of pregnancy, treatment with these non-twisted models becomes difficult. The next generation of flexible ureteroscopes, called flexible, has been introduced during pregnancy. With these devices, which are easily progressed in the urinary tract under pressure of the uterus under the pressure of the uterus, the patient is successfully free of stones between 70 and 100%. This method, which provides high comfort for patients, is expected to be the gold standard in the treatment of stone in pregnant women.
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