How symptomatic stone disease treated during pregnancy?
Ultrasound is the radiologic procedure of choice, although it may be difficult to interpret because ureters become dilated during pregnancy, making the diagnosis of hydronephrosis difficult.
If a patient has a symptomatic stone, hydration and observation to let the stone pass spontaneously are the preferred approaches.
If the stone does not pass and pain persists, infection/pyelonephritis is present, or there is complete unilateral obstruction, then the stone should be removed ureteroscopically. If the stone cannot be removed, then placement of a stent may be needed to relieve the obstruction.
ESWL is not recommended during pregnancy. Final surgical removal of a stone may be delayed until after delivery, if necessary.
Medical evaluation for the cause of the stone should be delayed until after pregnancy and nursing are over, because urine calcium excretion will be markedly different than the non-pregnant state.