PURPOSE: To determine the optimal imaging study by which to diagnose and treat pregnant patients with suspected urolithiasis.
MATERIALS AND METHODS: A retrospective, multi-center study was performed to determine the comparative accuracy of imaging modalities employed prior to surgical management of suspected urolithiasis in pregnant patients. Patients with clinical suspicion of urolithiasis were evaluated with directed imaging including renal ultrasound (RUS) alone, RUS and low-dose computed tomography (LDCT), or RUS and magnetic resonance urography (MRU). When indicated, patients were managed with therapeutic ureteroscopy. The rate of negative ureteroscopy was determined and the positive predictive values (PPV) of the imaging modalities were calculated.
RESULTS: A total of 51 pregnant patients underwent ureteroscopy. Mean age of the cohort was 27 years. Mean gestational age was 24.4 weeks. Twenty-four women (47%) underwent RUS and LDCT, 22 women (43%) underwent ultrasound alone, and 5 women (10%) underwent RUS and MRU. Negative ureteroscopy occurred in 7 of the 51 patients (14%). The rate of negative ureteroscopy among patients that underwent RUS alone, RUS and LDCT, and RUS and MRU was 23%, 4.2%, and 20%, respectively. PPV of CT, MR, and ultrasound were 95.8%, 80%, and 77%, respectively.
CONCLUSIONS: Among pregnant women undergoing intervention in our series, the rate of negative ureteroscopy was 14%. In the group taken to surgery after imaging with ultrasound alone, 23% had no ureteral stone, giving it the lowest PPV of the utilized modalities. Alternative imaging techniques, particularly LDCT, offer improved diagnostic information that can optimize management and obviate unnecessary intervention.
Written by:
White WM, Johnson EB, Zite NB, Beddies J, Krambeck AE, Hyams E, Marien T, Shah O, Matlaga B, Pais VM Jr. Are you the author?
Division of Urologic Surgery, The University of Tennessee Medical Center, Knoxville.
Reference: J Urol. 2012 Sep 24. pii: S0022-5347(12)04951-8.
doi: 10.1016/j.juro.2012.09.076
PubMed Abstract
PMID: 23017526
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