Management and outcomes of renal colic in pregnancy: A 10-year Australian tertiary centre experience

Abstract

Objective: To describe the presentation, management and maternal-foetal outcomes of pregnant patients with symptomatic upper tract obstruction. Patients and methods: A retrospective cohort study was performed of pregnant patients managed for renal colic or symptomatic hydronephrosis at a tertiary centre from 2014 to 2024. Patients were stratified by presence or absence of confirmed stone into symptomatic hydronephrosis and urolithiasis groups. Morbidity across conservative management, JJ stenting, percutaneous nephrostomy and primary ureteroscopy was assessed by hospital stay, subsequent procedures and emergency department re-presentations. Results: Seventy-two patients were included; 31 (43%) had urolithiasis, and 41 (57%) had symptomatic hydronephrosis. Twenty-one (29%) required intervention. Emergency department re-presentations differed across management groups ( p < 0.001). Percutaneous nephrostomy was associated with more emergency department re-presentations than JJ stenting (71% vs 17%; p = 0.0498) and longer hospital stay (12.1 vs 6.7 days; mean difference 5.5 days, 95% confidence interval 0.2–10.8; p = 0.044). The proportion requiring subsequent procedures was similar (86% vs 83%), although repeated interventions were more frequent after percutaneous nephrostomy (range: 0–8 vs 0–1). Obstetric outcomes did not differ between diagnostic groups. Conclusion: JJ stenting was associated with lower morbidity than percutaneous nephrostomy. Adverse obstetric outcomes appeared related to symptomatic obstruction irrespective of a confirmed calculus. Level of evidence: 2b