Management of Renal Colic during Pregnancy

ABSTRACT

To determine an optimal medical and invasive intervention for renal colic patients during pregnancy. Amongthe available interventions, we investigated the reliability of a medical and inavasive interventions duringpregnancy. Between Nov 2015 and Nov 2016, a total of 200 pregnant patients came to the obstetrics andgynaecology opd, and 15 of these patients had renal colic that were referred to urological opd. The meanpatient age was 30.49 years. In this retrospective cohort study, the charts of the patients were reviewed tocollect data that included age, symptoms, the lateralities and locations of urolithiasis, trimester, pain followingtreatment and pregnancy complications. Based on ultrasonography diagnosis, 15 patients had urolithiasis,all had ureteric calculi with one having hydronephrosis and pyonephrosis and other one patient havingsevere hydronephrosis, pyonephrosis and sepsis. Conservative treatment was successful in 13 patients.Five patients were in the first trimester and ten patients in the second trimester. Out of the five patients inthe first trimester four were managed conservatively using antibiotics, hydrations and analgesics and oneamong them had severe hydronephrosis with pyonephrosis with sepsis with upper ureteric calculi in whomconservative management failed and patient was counselled and MTP was done and following that PCNLwas done as a definitive procedure. Ten patients in the second trimester medical expulsive therapy usingTamsulosin .4mg was used and complete stone clearance was achieved in Nine patients and one didn'tresponded , developed severe hydronephrosis and pyonephrosis in whom USG guided PCN was placedfor rest of the gestational period and after delivery patient underwent PCNL and complete stone clearancewas achieved. Only one patient required urological intervention that is PCN insertion. Renal colic due tocalculus during pregnancy can be effectively managed by conservative measures using hydration,antibiotics,analgesics and tamsulosin .4mg in most of the instances. Cases who do not respond to the conservativemeasure or who develops severe hydronephrosis, pyonephrosis PCN insertion and Ureteral stent insertioncan be done and patient in who develops life threatening sepsis MTP should be done followed by definitivetreatment that is PCNL.