LAUSR

Introduction Approximately 3% of pregnancies are complicated by symptomatic hydronephrosis and up to 0.8% with urolithiasis. Pain, coupled with the possibility of superimposed infection, increases the risks of premature labour and delivery, fetal loss and caesarian sections. Surgical intervention as well as standard ionizing radiation imaging modalities are typically avoided making this a difficult, high risk patient cohort to manage. Herein we propose a standardized contemporaneous approach to investigations & management in the pregnant population with acute upper tract pathology. Methods A literature search of Pubmed, Cochrane and Embase databases was performed to identify original, peer-reviewed papers from 2010 onwards on the management of ureteric calculi and symptomatic hydronephrosis occurring during pregnancy. Search yielded 5,636 papers and following exclusions, 24 full-text papers met inclusion criteria for analysis. Evidence Synthesis Ultrasound remains the cornerstone of initial investigation with MRI in reserve if the diagnosis remains uncertain. Low dose CT imaging can be used in limited cases. Conservative approaches for symptomatic hydronephrosis as well ureteric calculi is the preferred initial management option in the well patient. If intervention is required, ureteric stent and nephrostomy can be employed with informed consent on the risks and benefits of each. Primary ureteroscopy with definitive stone management in centres with the appropriate expertise can safely deliver excellent stone free rates and symptomatic improvement. Conclusions Individualized investigation and management plans following a structured approach in pregnant women with symptomatic hydronephrosis or calculi is discussed. At all stages, the patient, obstetrician, anaesthetist and surgeon should be involved in a shared decision-making approach.