Gebelerde renal kolik yönetimi: tek merkez deneyimlerimiz

Year 2021, , 101 - 108, 29.12.2021

Şaban Oğuz Demirdöğen , Ahmet Cinislioğlu , Bakytbek Kozubaev Usenbekovich , Salih Al

https://doi.org/10.54233/endouroloji.1017699

Abstract

Amaç: Renal kolik nedeniyle başvuran gebe hastaların klinik özelliklerini, konservatif ve cerrahi tedavi sonuçlarını paylaşarak literatüre katkı sunmayı amaçladık.
Gereç ve Yöntemler: Hastaların demografik ve klinik özellikleri, gebelik haftaları, taş öyküsü, laboratuar ve radyolojik incelemeleri, hastalara uygulanan tedavilerin detayları, cerrahi tedavi uygulanan hastaların tedavi uygulamaları, komplikasyonlar, hastaların doğuma kadar olan takiplerindeki özellikleri retrospektif olarak incelenerek değerlendirildi.
Bulgular: Çalışmaya kliniğimizde takip ve tedavisi yapılan, renal kolikle başvuran 21 gebe hasta dahil edildi. Hastaların yaş ortalaması 27,2 ± 5.75 yıl idi. Ortalama gebelik haftası 20,1 ± 7.12 idi. Hastaların %14,3’ü ilk trimesterde, % 52,4’ü ikinci trimesterde, % 33,3’ü üçüncü trimesterde idi. Hastaların 14’ü (%66,7) sağ renal kolikle, 7’si (%33,3) sol renal kolikle başvurdu. Hastaların başvurudaki ortalama görsel analog skoru (VAS) skoru 8,38 ± 0,86 idi. Hastaların 20’sinde (%95,2) tanı ultrasonografi (USG) ile konuldu. Sadece 1 (%4,8) hastada tanı manyetik rezonans görüntüleme (MRG) ile konuldu. Hastaların 13’üne (%61,9) konservatif tedavi, 8’ine (%38,1) endoskopik cerrahi tedavi uygulandı. Cerrahi tedavi olarak tüm hastalara sadece Double J (DJ) stent konuldu. Konservatif tedavi ile takip edilen 32 haftalık bir gebede (%4,8) takiplerde erken membran rüptürüne bağlı erken doğum eylemi gelişti. Hastaların 4‘ünde (%19,0) doğum sonrası DJ stent çıkarılmasından başka ek üreteroskopik girişim gerekti. Konservatif tedavi ve cerrahi tedavi uygulanan hastalar ayrı ayrı değerlendirildiğinde her iki grup arasında demografik ve klinik özelliklerde istatistiksel olarak anlamlı fark saptanmadı.
Sonuç: Gebelikte renal kolik; tanı ve tedavi basamaklarındaki kısıtlılıklar, maternal ve fetal sağlığı etkileyebilecek potansiyel komplikasyonlar nedeniyle önemli ve multidisipliner bir yaklaşımla değerlendirilmesi gereken bir problemdir. Bu hastalar doğru tanı basamakları kullanılarak konservatif olarak ya da konservatif tedavinin başarısız olduğu durumlarda endoürolojik girişimlerle etkili ve güvenli bir şekilde tedavi edilebilirler.

Keywords

Gebelik, renal kolik, konservatif tedavi, cerrahi tedavi

Management of renal colic in pregnant patients: a single-center experience

Abstract

Objective: We aimed to contribute to the literature by sharing the clinical features, conservative and surgical treatment results of pregnant patients who applied for renal colic.
Material and Methods: The patients’ demographic and clinical characteristics were evaluated; gestational week, history of calculus, laboratory and radiological examinations, details of the treatments applied to the patients, treatment practices of the patients to whom surgical treatment was applied, complications, characteristics of the patients during the follow-up period until delivery retrospectively.
Results: Twenty-one pregnant patients, who were followed up and treated at the department and applied with renal colic, were included in the study. The mean age of the patients was 27.2 ± 5.75 years. The average gestational week was 20.1±7.12. Of the patients, 14.3% were in the first trimester, 52.4% in the second trimester, and 33.3% in the third trimester. Fourteen patients (66.7%) applied with right renal colic and 7 (33.3%) with left renal colic. The mean visual analog scale (VAS) score at the time of application of the patients was 8.38 ± 0.86. The diagnosis was made via the ultrasonography (US) in 20 patients (95.2%). Magnetic resonance imaging (MRI) was only used in 1 (4.8%) patient. Conservative treatment was applied to 13 patients (61.9%) and surgical treatment to 8 patients (38.1%). Only a DJ stent was placed in all patients as surgical treatment. Due to premature rupture of membrane, premature labor developed in a 32-week pregnant woman (4.8%), followed up with conservative treatment. An additional ureteroscopic intervention was required in 4 of the patients (19.0%) other than the postpartum removal of the DJ stent. When the patients, who underwent conservative and surgical treatment, were separately evaluated, no statistically significant difference was observed between the two groups regarding demographic and clinical characteristics.
Conclusion: Renal colic in pregnancy is an important problem due to the limitations in diagnosis and treatment steps and potential complications that may affect maternal and fetal health, and it should be assessed with a multidisciplinary approach. Patients can be treated efficiently and safely via conservative treatment using the correct diagnostic steps or via endourological interventions if the conservative treatment fails.

Keywords

pregnancy, renal colic, conservative treatment, surgical treatment, pregnancy, renal colic, conservative treatment, surgical treatment

References

• 1. Andreoiu M, MacMahon R. Renal colic in pregnancy: lithiasis or physiological hydronephrosis?. Urology. 2009;74(4):757-761. doi:10.1016/j.urology.2009.03.054
• 2. Akay F, Gedik A: Özel Durum 1: Gebede Renal Kolik. Diyarbakır: Turkiye Klinikleri J Surg Med Sci. 2007;3(20):33-6
• 3. Blanco LT, Socarras MR, Montero RF, et al. Renal colic during pregnancy: Diagnostic and therapeutic aspects. Literature review. Cent European J Urol. 2017;70(1):93-100. doi:10.5173/ceju.2017.754
• 4. Choi CI, Yu YD, Park DS. Ureteral Stent Insertion in the Management of Renal Colic during Pregnancy. Chonnam Med J. 2016;52(2):123-127. doi:10.4068/cmj.2016.52.2.123
• 5. Wein AJ, Kavoussi LR, Novick AC, et al. Campbell-walsh Urology. Matlaga BR, Lingeman JE(ed) Urinary Calculi During Pregnancy, 10th edn. Elsevier, Philadelphia, 2012; pp 1379-1382
• 6. Zwergel T, Lindenmeir T, Wullich B. Management of acute hydronephrosis in pregnancy by ureteral stenting. Eur Urol. 1996;29(3):292-297. doi:10.1159/000473763
• 7. Koren G, Florescu A, Costei AM, Boskovic R, Moretti ME. Nonsteroidal antiinflammatory drugs during third trimester and the risk of premature closure of the ductus arteriosus: a meta-analysis. Ann Pharmacother. 2006;40(5):824-829. doi:10.1345/aph.1G428
• 8. Deters LA, Belanger G, Shah O, Pais VM. Ultrasound guided ureteroscopy in pregnancy. Clin Nephrol. 2013;79(2):118-123. doi:10.5414/CN107654
• 9. Wayment RO, Schwartz BF. Pregnancy and Urolithiasis [Internet] USA: Emedicine; c2009. [Updated 2015 Apr 17]. [Cited 2014 Nov 19]. Available from: http://emedicine.medscape.com/article/455830-overview/
• 10. Semins MJ, Matlaga BR. Management of urolithiasis in pregnancy. Int J Womens Health. 2013;5:599-604. Published 2013 Sep 30. doi:10.2147/IJWH.S51416
• 11. EAU Guidelines. Edn. presented at the EAU Annual Congress Milan 2021. ISBN 978-94-92671-13-4.
• 12. Medicines and Healthcare Products Regulatory Agency. "Safety guidelines for magnetic resonance imaging equipment in clinical use." (2015).
• 13. Committee on Obstetric Practice, Committee Opinion No. 723: Guidelines for Diagnostic Imaging During Pregnancy and Lactation. Obstet Gynecol,2017. 130: e210.
• 14. McAleer SJ, Loughlin KR. Nephrolithiasis and pregnancy. Curr Opin Urol. 2004;14(2):123-127. doi:10.1097/00042307-200403000-00013
• 15. Lee SJ, Rho SK, Lee CH, Chang SG, Kim JI. Management of urinary calculi in pregnant women. J Korean Med Sci. 1997;12(1):40-43. doi:10.3346/jkms.1997.12.1.40
• 16. Evans HJ, Wollin TA. The management of urinary calculi in pregnancy. Curr Opin Urol. 2001;11(4):379-384. doi:10.1097/00042307-200107000-00007
• 17. Ngai HY, Salih HQ, Albeer A, Aghaways I, Buchholz N. Double-J ureteric stenting in pregnancy: A single-centre experience from Iraq. Arab J Urol. 2013;11(2):148-151. doi:10.1016/j.aju.2013.02.002
• 18. Teleb M, Ragab A, Dawod T, et al. Definitive ureteroscopy and intracorporeal lithotripsy in treatment of ureteral calculi during pregnancy. Arab J Urol. 2014;12(4):299-303. doi:10.1016/j.aju.2014.08.005
• 19. Adanur S, Ziypak T, Bedir F, et al. Ureteroscopy and holmium laser lithotripsy: is this procedure safe in pregnant women with ureteral stones at different locations?. Arch Ital Urol Androl. 2014;86(2):86-89. Published 2014 Jun 30. doi:10.4081/aiua.2014.2.86
• 20. Zhang S, Liu G, Duo Y, Wang J, Li J, Li C. Application of Ureteroscope in Emergency Treatment with Persistent Renal Colic Patients during Pregnancy. PLoS One. 2016;11(1):e0146597. Published 2016 Jan 11. doi:10.1371/journal.pone.0146597
• 21. Srirangam SJ, Hickerton B, Van Cleynenbreugel B. Management of urinary calculi in pregnancy: a review. J Endourol. 2008;22(5):867-875. doi:10.1089/end.2008.0086