Editing CUA: Ureteral Calculi (2015) (section)

=== Pregnancy ===

* '''Diagnosis'''
** '''Ultrasound is the preferred choice in suspected urolithiasis in pregnancy due to lack of radiation; however, ultra-low dose CT (<1.9 mSV) or MRI are good alternatives with very little or no radiation [Note that use of KUB plain film (0.7mSV) is not described]'''
** '''If ultrasound imaging is non-diagnostic and low-dose CT or MRI are unavailable, URS can be used as both diagnostic and therapeutic procedure.'''
*** '''URS with laser lithotripsy with flexible or semi-rigid is feasible and safe; ideally done in the second trimester as teratogenic effects and risks are higher in the first trimester'''
* '''Treatment'''
** '''First-line: conservative therapy''' (including hydration and analgesia)
*** '''Indications for immediate diversion same as non-pregnant patients, but also include induction of premature labour'''
** '''Second-line: URS'''
*** '''Postoperative stenting following URS in this situation is recommended to reduce postoperative complications'''
*** '''SWL contraindicated in pregnancy'''
*** '''PCNL, if necessary, should be delayed until after birth as the procedure requires prolonged anesthesia and radiation exposure'''