PDF(Pubmed)
Abstract：
The management of symptomatic hydronephrosis presents substantial challenges due to the absence of consensus within clinical guidelines concerning pain management, diagnostic approaches, therapeutic interventions, and follow-up protocols. This literature review focuses on complexities involving diagnostic challenges that arise from the difficulty in distinguishing physiological from pathological obstruction and treatment complexities that involve deciding on the most appropriate pain management medications and safe interventions while minimizing risks to both the mother and foetus. To address these challenges, a comprehensive search of electronic databases, including PubMed, Embase, and Google Scholar, was conducted for the terms \"hydronephrosis\", \"hydronephrosis in pregnancy\", \"ionising radiation in pregnancy\", and \"safe analgesia in pregnancy\". Moreover, Mendeley software was used to collect and organize the references. Diagnostic complexities involve selecting the appropriate imaging modality that balances accurate diagnosis with minimal radiation to the foetus. Ultrasound remains the first-line option. However, it has limitations in delineating the underlying aetiology. MRI avoids ionizing radiation but has restricted utility due to foetal movement artifacts. CT provides the highest diagnostic accuracy but raises foetal radiation exposure concerns, though ultra-low dose protocols (<1 mGy) are deemed acceptable by most guidelines. Management includes either a conservative approach, which is a safe option in the majority of cases, or intervention with a percutaneous nephrostomy or ureteric stent insertion, both with comparable symptom control. However, there is no consensus on the optimal frequency for drain changes to prevent rapid encrustation. Definitive procedures like ureteroscopy and percutaneous nephrolithotomies remain controversial. Most guidelines suggest limiting these interventions to specialist centres during the second trimester if required.
摘要：
有症状的肾积水的治疗提出了巨大的挑战，由于缺乏关于疼痛管理的临床指南的共识。诊断方法，治疗性干预措施,和后续协议。这篇文献综述的重点是涉及诊断挑战的复杂性，这些挑战是由于难以区分生理性和病理性梗阻以及治疗复杂性而引起的，这些复杂性涉及决定最合适的疼痛管理药物和安全干预措施，同时最大程度地降低母亲和胎儿的风险。为了应对这些挑战，全面搜索电子数据库，包括PubMed,Embase,和谷歌学者，是针对“肾积水”一词进行的，“妊娠肾积水”，“怀孕期间的电离辐射”，和“怀孕安全镇痛”。此外，使用Mendeley软件来收集和组织参考文献。诊断复杂性涉及选择适当的成像模式，以平衡准确的诊断与对胎儿的最小辐射。超声仍然是一线选择。然而,它在描绘潜在的病因方面有局限性。MRI避免了电离辐射，但由于胎儿运动伪影而限制了实用性。CT提供最高的诊断准确性，但增加了胎儿的辐射暴露问题，尽管超低剂量方案（<1mGy）被大多数指南认为是可以接受的。管理包括保守的方法，在大多数情况下，这是一个安全的选择，或经皮肾造口术或输尿管支架插入介入，两者都具有可比的症状控制。然而,对于防止快速结壳的排水沟更换的最佳频率没有共识。输尿管镜检查和经皮肾镜取石术等明确的手术仍存在争议。大多数指南建议，如果需要，在孕中期将这些干预措施限制在专科中心。
