About one out of every 150 pregnant women have kidney stone problems. Although there is no increase in the frequency of stones detected in pregnant women, existing stones fall into the urinary canal more frequently due to relaxation in the urinary canals with pregnancy, causing painful pictures.
How Does Kidney Stone Form During Pregnancy?
Even if there are no stones at the time of pregnancy, it is considered natural to encounter a certain amount of swelling in the kidneys. The reason for this is that the canals that transmit urine from the kidney to the urinary bladder are compressed due to the enlarged womb with pregnancy, as well as the hormonal changes that occur during pregnancy, which loosen the urinary canals and contribute to relative swelling.
This swelling in the kidneys, which is considered natural, starts between the 6th and 10th weeks of pregnancy and may last up to the 6th week after delivery. While such swellings do not cause pain, kidney swellings that cause unilateral pain should raise the suspicion of stones. and it is important not to miss the diagnosis.
Why Is It Difficult to Diagnose Kidney Stones During Pregnancy?
Diagnosis of stones in pregnancy is not as easy as in non-pregnant patients. While the classic symptoms of kidney stones, such as flank pain, nausea, vomiting and frequent urination, are seen in pregnant women without stone disease, stone pain can be felt in different locations such as the waist and groin, depending on the growing uterus in pregnant women, making it difficult for the doctor to interpret the pain.
Can Kidney Stones During Pregnancy Be Determined by Methods?
In addition to the difficulty in physical examination, imaging methods that can be used during the diagnosis of stones in pregnancy are also limited. In particular, the use of radiation-containing imaging methods such as computed tomography (CT), intravenous pyelography (IVP), fluoroscopy above a certain dose causes an increase in the risk of cancer as well as negatively affecting the physical and mental development of the baby in the womb.
These radiation-containing methods are too complex for pregnant women to be diagnosed with only other methods� It would be appropriate to use it in cases that are light and threatening the life of the mother or the baby.
However, ultrasound, which does not contain radiation, is safe for the baby in the mother's womb, and therefore, it can be easily used as the first preferred imaging method in pregnant women with suspected stones. The diagnostic ability of ultrasound decreases significantly in kidney swelling that developed naturally during pregnancy or in stones that have caused new obstruction that cannot yet cause swelling.
Magnetic resonance imaging (MR) is an imaging method that can be used safely in pregnant women. With this method, changes in the kidneys and urinary canals can be clearly visualized. The problem with MRI is that the stone itself does not give a clear image on MRI. Therefore, while MRI can clearly show that there is an obstruction in the urinary canal, it cannot give clear information about the cause of the stenosis.
How to Treat Kidney Stones in Pregnancy?
A personalized treatment should be planned for each patient. In diagnosed stones, the general condition of the patient, the duration of pregnancy, the size and location of the stone determine the general lines of treatment. For this reason, all pregnant women whose pain and nausea can be controlled with oral medications and whose kidney swelling does not progress to a critical level are followed.
In patients whose general condition deteriorates and whose pain and nausea cannot be controlled with oral medications, additional treatment methods should be sought. The main purpose of the treatment is to restore the urine flow without harming the pregnant mother and her baby in her womb, and to control the pain and nausea. In this procedure, a catheter and a rubber tube are inserted into the canal clogged with stones between the kidney and the urinary bladder, passing by the stone. This rubber tube remains inside the patient during pregnancy and many It ensures that the problems in pregnant women are postponed until the definitive treatment after pregnancy.
In some pregnant women, this tube is insufficient to relieve the stone pain, causes sensitivity and pain in the urinary bladder, and significantly reduces the quality of life of the pregnant with the need to go to the toilet frequently. ESWL, which is a method of breaking stones with external sound waves, is inconvenient to use in pregnant women. With the help of special devices called ureteroscope, which has a light and camera at the tip, it is entered through the urinary hole and proceeded through the urinary canal under direct vision, and when the stone is encountered, it is broken up with a laser. The ones in general use of these devices, called ureteroscopes, are rigid, metal models that allow bending only 5-7 degrees.
However, when the uterus is above a certain size, especially in the advanced weeks of pregnancy, treatment becomes difficult with these non-bending models. It has come to the fore to offer treatment with the next generation bendable ureteroscopes called flexible during pregnancy. With these devices, which move easily in the urinary canal under the pressure of the mother's uterus with their bendability, the patient is freed from stones with a success rate of 70 to 100%. This method, which provides high comfort for patients, is expected to be the gold standard in stone treatment in pregnant women.
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