Renal colic during pregnancy: a case for conservative treatment.

PURPOSE: We defined the merits of early evaluation and conservative treatment of pregnant patients admitted with renal colic.

MATERIALS AND METHODS: We retrospectively evaluated 72 pregnancies in 70 patients who were hospitalized with the diagnosis of renal colic between 1984 and 1995. Urinalysis was performed in every case. Ultrasound was the primary diagnostic test in 65 patients. The patients were followed for 2 weeks to 3 months after delivery (mean 21 days).

RESULTS: Mean patient age at presentation was 27.4 years. The majority of patients were multiparous (47 of 70) and presented in the third trimester (44 of 70). Microscopic urinalysis was not helpful in identifying stone disease in pregnant patients. The sensitivity of ultrasound for the diagnosis of renal calculi was 95.2%. Watchful conservative nonsurgical treatment resulted in spontaneous passage of stones in 64.3% of cases. Of the 19 pregnancies in which intervention was necessary cystoscopy and Double-J* silicone stent placement were done in 15, and ureteroscopy and stone basketing were done in 4. Two patients, who presented with pyelonephritis and premature ruptured membranes had fetal loss. Long-term antibiotic prophylaxis was maintained in all stented and bacteriuric patients.

CONCLUSIONS: Renal colic in pregnant patients can be complicated by pyelonephritis and premature labor, especially if misdiagnosed or inadequately treated. Ultrasound is a safe and sensitive diagnostic test. Approximately two-thirds of renal calculi will pass spontaneously. For those who require intervention, placement of a Double-J stent is a safe and effective option.