Login to Access Video or Poster Abstract: MP95-11
Sources of Funding: None

Introduction

To review the evaluation and management of pregnant patients with clinically symptomatic nephrolithiasis evaluated at a single institution over a 14-year period.

Methods

A retrospective chart review was performed to identify pregnant patients admitted with a diagnosis of nephrolithiasis at a single institution from 2002-2016. Admission rates, lengths of stay, rates of sepsis, utilization of imaging, administration of MET, rates and type of surgical intervention, and gestational outcomes were analyzed through the patient&[prime]s gestational period.

Results

695 pregnant patients with symptomatic nephrolithiasis were identified, 304 of whom delivered at our institution and were included in the analysis. Average maternal age was 30.4 years (range 17-48). Of these, 262 (86.2%) had imaging interpreted as consistent with nephrolithiasis. 261 (85.9%) underwent US, 16 (5.3%) CT scan, and 4 (1.3%) MRI. The remaining 42/304 patients (13.8%) were diagnosed based on history and symptoms alone. 40 patients (13.2%) were started on tamsulosin during their pregnancy. 242 (80%) patients had culture data, 33/242 (13.6%) which were positive. 32 (10.5%) patients underwent surgical management, 2 in the first trimester, 17 in the second, and 13 in the third. Patients were more likely to receive definitive surgical management in the first trimester (2/2, 100%) versus 10/30 (33.3%) later in pregnancy (p<0.05). 6/32 (18.8%) of patients in the surgical group presented with ≥ 2 SIRS criteria. Patients in the MET group were more likely to undergo surgical management (p<0.05). There was a statistically significant correlation between the rate of operative intervention and the number of hospital encounters (p<0.05) as well as length of stay (p<0.05). No statistically significant correlation was seen in the rates of preterm labor or APGAR scores in patients who underwent surgery versus those who did not._x000D_

Conclusions

To our knowledge, this is the largest study focused on the management of symptomatic nephrolithiasis in pregnant women. The majority of patients had a diagnosis confirmed by imaging, primarily with ultrasound. Definitive surgical management was more likely to occur in the first trimester. Patients receiving MET were more likely to require surgical intervention. Surgical intervention was not associated with preterm labor or low APGAR scores.

Funding

None