Urolithiasis in Pregnancy: Management Strategies and Maternal-Fetal Outcomes

Abstract

Introduction: Symptomatic urolithiasis during pregnancy poses diagnostic and therapeutic challenges due to radiation avoidance and teratogenicity risks. This systematic review compares conservative, interventional, and surgical management strategies.

Methods: We searched Embase, Scopus, and the Cochrane Pregnancy and Childbirth Group (2010–2024) for case series, cohort studies, and RCTs. Inclusion: pregnant women with confirmed urolithiasis (ultrasound or MRI). Outcomes: spontaneous passage rate, need for intervention, preterm delivery, and obstetric complications. Quality assessed using NIH tool.

Results: Thirty-four studies (n=1,206 pregnancies) were included. Spontaneous passage occurred in 68% of stones ≤5 mm (95%CI 62–74%). For persistent obstruction, ureteroscopic stone extraction (URS) had a success rate of 92% with a 7% preterm delivery rate. Percutaneous nephrostomy (PCN) had lower success (74%) but similar preterm rate (8%). Shockwave lithotripsy was not performed due to fetal concerns.

Discussion: Conservative management is appropriate for small stones. URS is effective and reasonably safe after the first trimester. PCN is a temporizing measure. Most studies were retrospective, with small sample sizes. Standardized obstetric follow-up protocols were often missing.

Conclusions: First-line management of urolithiasis in pregnancy is observation for stones ≤5 mm. For refractory cases, ureteroscopy (second/third trimester) is the preferred intervention. Multidisciplinary urology-obstetrics teams improve outcomes.