Urinary Tract Calculi

The incidence of urinary lithiasis during pregnancy is on the order of 1:200 to 1:1,500 (Evans and Wollin 2001; Gorton and Whitfield 1997; Loughlin 1997; McAl-ler and Loughlin 2004; Meria et al. 1993; Stothers and Lee 1992), with the mean figure of 1: 1,500 cited most often. This incidence is identical in women who are not pregnant (Biyani and Joyce 2002a; McAleer and Loughlin 2004; Saidi et al. 2005). Onset occurs eight or nine times out of ten during the 2nd or 3rd trimester (Leap-hart et al. 1997; McAleer and Loughlin 2004; Meria et al. 1993; Stothers and Lee 1992). It is more frequent in multiparous women (Kroovand 1992; Stothers and Lee 1992). The calculi are essentially composed of calcium carbonitee and more rarely of struvite (Meria et al. 1993; Saidi et al. 2005; Stothers and Lee 1992). The revealing symptom is most often lower back pain (89%) followed by microscopic hematuria, sometimes macroscopic hematuria (95%) (Leaphart et al. 1997; McAleer and Loughlin 2004; Stothers and Lee 1992). Symptoms can be deceptive, bringing to mind cholecystitis or right-sided appendicitis, left-sided sigmoiditis, an occlusion, adnexal pathology, or placental detachment (Biyani and Joyce 2002a; Evans and Wollin 2001; McA-leer and Loughlin 2004). Elsewhere, the calculus is discovered by signs in the lower urinary structures, abortion, the threat of premature delivery (Biyani and Joyce 2002a; Loughlin 1994), atypical abdominal pain, or nausea or vomiting (Evans and Wollin 2001). More rarely, lithiasis presents as an infectious complication or anuria (Carringer et al. 1996; Meria et al. 1993; Sto-thers and Lee 1992).

While seven or eight urinary calculi out of ten are eliminated spontaneously, medical treatment should be proposed initially. Rest and sufficient hydration (2 - 31/ 24 h) are prescribed. When pain is present, fluid restriction is routine. The proper procedure is summarized in Fig. 7.1.

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