management of ureteric stones during pregnancy
DESCRIPTION
Management of HYDRONEPHROSIS during PREGNANCY URETERIC STONES DURING PREGNANCY with safe material and fetal outcome. She presented her 10 years experience with such cases at international Urogynecology conference held at IRELAND in 2013TRANSCRIPT
DR. K. LALITHAM.D., M.Ch.(UROLOGY)
UROLOGIST & GYNECOLOGIST
MBBS – KMC, WARANGAL-1988MD(OBG)-PGIMER(CHANDIGARH)-1991MCh(UROLOGY)-OMC(HYD)-1997AREA OF INTEREST-FEMALE UROLOGY
UROGYNECOLOGY
MANAGEMENT OF URETERIC STONES DURING PREGNANCY
DR.LALITHAUROLOGIST &UROGYNECOLOGISTYASHODA HOSPITAL,SOMAJIGUDA
INTRODUCTION
• RENAL COLIC IS THE MOST COMMON NON-OBSTETRIC INDICATION FOR HOSPITALIZATION
• UROLITHIASIS INCREASES THE RISK OF PRETERM LABOUR FROM 3% TO 7%
• UROLITHIASIS AFFECTS 1 IN 200 TO 1IN 1500
INTRODUCTION
• CONSERVATIVE TREATMENT IS THE MAINSTAY
• 15% REQUIRE UROLOGICAL INTERVENTION
• DOUBLE J STENTING WAS THE STANDARD FORM OF TREATMENT
AIM
• TO STUDY THE SAFETY AND FEASIBILITY OF URETEROSCOPIC LITHOTRIPSY DURING PREGNANCY
• TO DISCUSS THE DIAGNOSTIC & THERAPEUTIC CHALLENGES
MATERIAL & METHODS
A RETROSPECTIVE STUDY OF 220 PREGNANT WOMEN WITH UROLITHIASIS TREATED BY US BETWEEN FEB 2002 TO FEB 2012
40 WOMEN REQUIRED ACTIVE ENDOUROLOGICAL INTERVENTION.
DIAGNOSTIC TOOLS
• ULTRASOUND KUB - DD PHYSIOLOGICAL HYDRONEPHROSIS
• MR UROGRAPHY
• IVP / CT ARE CONTRAINDICATED
INDICATIONS FOR INTERVENTION
• RENAL COLIC
• INCREASING HYDRONEPHROSIS
• UROSEPSIS
• OLIGURIA / ANURIA
Lower ureteric stone with hydroureter
RESULTS -TYPE OF INTERVENTION
• URETEROSCOPIC STONE REMOVAL FOR DISTAL URETERIC STONES - 18
• DOUBLE J STENTING FOR WOMEN WITH PROXIMAL URETERIC STONES - 22
RESULTS
• 18 - DISTAL URETERIC STONES• 3 STONES > 1 CM
• 1 CASE OF TWIN PREGNANCY
• 1 - BICORNUATE UTERUS
RESULTS
COMPLICATIONSUROLOGICAL - UROSEPSIS - NIL URETERIC PERFORATION – NIL
OBSTETRIC - PRETERM LABOUR - 1
DISCUSSION
• URETERIC STONE DURING PREGNANCY MAY SOMETIMES REQUIRE UROLOGICAL INTERVENTION
• DIAGNOSTIC DILEMMA DUE TO PHYSIOLOGICAL HYDRONEPHROSIS DUE TO INABILITY TO USE X-RAYS
DISCUSSION
• THERAPEUTIC CHALLENGES
• ESWL CONTRAINDICATED• INTRA-OP C-ARM CANNOT BE USED• DIFFICULT TO ACCESS PROXIMAL URETER• RISK OF ANAESTHESIA TO THE FETUS
DISCUSSION
• DOUBLE J STENTING - STANDARD APPROACH
• RECENT ADVANCES IN ENDOUROLOGY MADE URETEROSCOPIC LITHOTRIPSY A SAFER ALTERNATIVE
ADVANTAGES
• SECOND PROCEDURE AVOIDED
• STENT RELATED COMPLICATIONS AVOIDED• LUTS• HEMATURIA• ENCRUSTATIONS
CONCLUSION
• URETEROSCOPIC LITHOTRIPSY DURING PREGNANCY IS FEASIBLE AND SAFE IN A SELECT GROUP OF PATIENTS IN A WELL EQUIPPED ENDOUROLOGY UNIT
• A TEAM OF EXPERTS IN UROLOGY, OBSTETRICS,RADIOLOGY & ANAESTHESIOLOGY IS ESSENTIAL FOR OPTIMAL OUTCOME.