LAUSR

Urolithiasis can occur in up to 1% of pregnant women and its association with negative fetal outcomes such as premature labor, low birth weight, preeclampsia, and urinary tract infection (UTI) is well established. Obstructive urolithiasis may pose a challenging situation during pregnancy because of the limitations in diagnostic imaging employable. In addition, it needs to be differentiated from physiological hydronephrosis occurring in up to 80% of pregnancies, thus making differential diagnosis arduous. In this context, Ha and coworkers investigated the association between pregnancy and patterns of decompression as well as maternal and fetal outcomes after delayed decompression in a group of women presenting with obstructing ureteral stones. The first key finding is that decompression rates among pregnant patients resulted significantly lower compared with the nonpregnant population. In addition, pregnant women were more likely to experience a delay in treatment for such conditions. This finding may be ascribed also to an initial misdiagnosis and, thus, might imply higher rates of Csection, fetal distress, early or threatened labor and umbilical cord complications. Second, the paper provides some interesting “food for thoughts” in terms of treatment options. Whenever urinary decompression was performed, pregnant women were more likely to undergo percutaneous nephrostomy (PCN) placement rather than ureteral stenting. Interestingly, the former was associated with a higher risk of septic complication, while fetal outcomes did not differ between PCNs and ureteral stenting. Consistently, a recent propensity score-matched study did not find any significant difference in risk of premature labor and delivery, premature rupture of membranes, or intrauterine infection between the two treatment options. Moreover, ureteral stenting was associated with a reduced risk of UTIs, emergency department visits, and hospitalizations. Notwithstanding, although ureteral stenting seems to exert a protective role in terms of infective complications, it must be kept in mind that it represents a temporary and sometimes poorly tolerated measure, burdened by precocious encrustations during pregnancy. In this regard, recent evidence suggested that endoscopic lithotripsy may represent a safe option when dealing with the elective treatment of urolithiasis in pregnancy, as it demonstrated a high-stone free rate and low risk of complications. All in all, this clinical scenario is still difficult to navigate and requires close collaboration between obstetrics and urologists. Further evidence is eagerly warranted to corroborate the authors’ findings.