Kumar, N S (2009) Management of Ureteric Obstruction in Pregnancy. Masters thesis, Kilpauk Medical College, Chennai.
|
Text
180400409kumar.pdf Download (447kB) | Preview |
Abstract
INTRODUCTION: Urolithiasis is the most common cause of nonobstetrical abdominal pain that requires hospitalization among pregnant patients. The relative incidence and rate of recurrent calculi in pregnant patients (1 per 1500 pregnant patients) is similar to that in nonpregnant patients. Symptomatic stones are found in the ureter twice as often as in the renal pelvis and affect both ureters in equal frequency. Eighty to ninety percent are diagnosed after the first trimester. Urolithiasis in pregnancy is often a diagnostic and therapeutic challenge for multiple reasons. First, potential adverse effects of anesthesia, radiation, and surgery often complicate traditional diagnostic and treatment modalities. Second, many signs and symptoms of urolithiasis can be found in a pregnancy or may be associated with broad differential diagnoses of other sources of abdominal pathology. Finally, most stones (64-84%) pass spontaneously with conservative treatment. However, if the calculus does not pass, it may initiate premature labor, produce intractable pain, cause urosepsis in the setting of urinary tract infection, or interfere with the progression of normal labor. AIM OF THE STUDY: 1. To analyse various diagnostic procedures in the management of ureteric obstruction during pregnancy. 2. To assess the various therapeutic modalities during pregnancy in the management of ureteric obstruction. 3. To discuss the factors which decide selection of procedures. 4. To analyse the complications associated with ureteric obstruction in pregnancy and its management. 5. To analyse the outcome. MATERIALS AND METHODS: Our study is a prospective study of management of ureteric obstruction for the period from July 2006 to March 2009 at our institutions, Govt Royapettah Hospital & Kilpauk Medical College Hospital. My study consists of about 20 pregnancy patients presented with ureteric obstruction from age group of 20 to 29 years. All pregnant patients with signs and symptoms of ureteric colic were included. All patients screened with Urine analysis, Urine culture and sensitivity, Renal parameters, Hemogram and Ultrasound abdomen. Trans vaginal ultrasound was done in symptomatic patients who were not showing stones in USG abdomen and stones in lower ureter. Color Doppler ultrasound done in patients who were not showing stones in other modalities of above investigations. All patients were initially treated with conservative line of management. Indications for intervention : Intractable pain unresponsive to maximal conservative measures. • Urosepsis • Azotemia • Premature labour not responding to Tocolytics. TREATMENT MODALITIES: 1. Stenting under local anaesthesia. 2. URS / Lithotripsy under spinal anaesthesia All patients were followed up till stone clearance or till delivery. RESULTS: Among 20 patients, 2 in I trimester, 10 in II trimester and 8 in III trimester. The age group included in this study between 20-29 years. The patients with right sided ureteric obstruction was 13 and left sided ureteric obstruction was 7. All patients presented with ureteric colic and 9 patients presented with microscopic hematuria and 3 patients with UTIs. USG abdomen done for all 20 patients and all of them showed HUN. In addition, 9 patients showed calculus ( 5 in upper ureter and 4 in lower ureter). Trans vaginal USG done in patients with lower ureteric calculus and HUN without calculus in USG. Additional 5 lower ureteric calculus were detected by trans vaginal USG. The color Doppler USG done in patients who were not showing calculus but HUN in USG abdomen and trans vaginal USG. The color Doppler showed obstruction in 4 out of 6 patients and no obstruction in 2 patients. CONCLUSION: Urolithiasis remains a diagnostic and therapeutic challenge. • High index of clinical suspision is necessary. • While choosing the diagnostic / therapeutic modalities it must be 100% safe to mother and fetus. • Goals of therapy must be - To keep the kidney functioning - Patients must be free of symptoms. - Not to disturb the ongoing pregnancy. • Ultrasonography remains the cornerstone of imaging. • Evaluation with Transvaginal USG to assess distal ureteric stone. • Doppler USG can be used with full safety to detect obstruction (Indirect evidence of calculus ) • URS and Lithotripsy are : - Both Diagnostic / therapeutic are safe. • As most stones will pass spontaneously , expectant management with supportive care should be attempted, but stenting and definitive ureteroscopy are highly successful if required . • Although the expectant mother who has flank pain is often approached with trepidation , the combination of a high index of suspicion, careful regard for the mother and fetus and use of well established endo urologic techniques maximize the possibly of an excellent, stone free outcome.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Ureteric Obstruction ; Pregnancy ; Management. |
| Subjects: | MEDICAL > Urology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 12 Oct 2017 01:09 |
| Last Modified: | 12 Oct 2017 01:09 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3440 |
Actions (login required)
 |
View Item |
