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Urinary Stone Disease in Pregnancy: Current Management Practices in a Large National Cohort - Beyond the Abstract

The management of urinary stone disease during pregnancy is challenging. In the United States, eight out of 1000 pregnancies involve a urinary stone diagnosis,1 and stone disease represents the most common non-obstetric reason for hospitalization in pregnant women.2 When occurring during pregnancy, stone disease is associated with an increased risk of adverse maternal and fetal events, including preeclampsia, eclampsia, premature delivery, and even spontaneous abortion.1 However, current management strategies of stone disease during pregnancy are not well-described. We performed an insurance claims-based analysis in over 1.8 million pregnant women in the United States between 2011 – 2016 to define contemporary practice patterns for the diagnosis and treatment of urinary stones in pregnancy.



Of the 14,298 women identified with a diagnosis of urinary stone disease during their pregnancy, renal ultrasound was the most commonly used diagnostic imaging modality (74%). Abdominal x-ray and MRI studies were utilized in 9% and 2.8% of women, respectively, and virtually no women in our cohort underwent CT imaging as a diagnostic modality for stone disease during pregnancy. We found that the majority of pregnant women with stone disease are managed non-operatively with only 5% undergoing procedural intervention during their pregnancy. Seven hundred and seventy-six (3.3%) underwent ureteral stent placement without definitive stone treatment during pregnancy and only 32 (6.7%) of those patients underwent a stent exchange during pregnancy with a median stent dwell time of five weeks. One hundred and eighty (1.3%) underwent ureteroscopy during pregnancy for definitive stone treatment, and of these, 27 (15%) cases were performed after 34 weeks of gestation.

To our knowledge, the methodology used in our present study has generated the largest dataset of pregnant women with urinary stone disease. We found that urinary stone disease is largely diagnosed by ultrasound during pregnancy. Procedure-based decisions are largely made in the absence of CT imaging and 95% of women are managed non-operatively during pregnancy. Limitations of our study include the use of diagnosis and procedural codes to identify patients and the possibility of bias towards patients of higher socioeconomic status who have employer-based health insurance. Nevertheless, our study provides contemporary real-world evidence of management patterns of urinary stone disease during pregnancy that can serve as a useful baseline as practice patterns continue to evolve in the future.

Written by: Kyle Spradling, MD, Urology Resident, Department of Urology, Stanford University, Stanford, California, Twitter: @SpradlingKyle

References:

  1. Sohlberg, Ericka M., William D. Brubaker, Chiyuan Amy Zhang, Leander DL Anderegg, Kai Dallas, Shen Song, Calyani Ganesan et al. "Urinary Stone Disease in Pregnancy: A Claims-Based Analysis of 1.4 Million Patients." The Journal of urology (2019): 10-1097.
  2. Swartz, Mia A., Mona T. Lydon-Rochelle, David Simon, Jonathan L. Wright, and Michael P. Porter. "Admission for nephrolithiasis in pregnancy and risk of adverse birth outcomes." Obstetrics & Gynecology 109, no. 5 (2007): 1099-1104.
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