简介:由于担心可能造成胎儿伤害的调查和治疗,怀孕期间肾结石的管理可能会给泌尿科医师带来压力。并且不熟悉这些复杂患者的最佳管理。作为回应,我们制定了基于多学科证据的指南,以规范出现侧腹疼痛和怀疑肾结石的产科患者的护理.方法:涉及泌尿外科的多学科团队,产科麻醉学,妇产科,放射诊断学,和介入放射学从一个学术医疗中心组装。使用怀孕/产前的关键字进行PubMed搜索,肾结石/结石/肾结石,输尿管镜检查,非产科手术,并发症,早产,MRI,计算机断层扫描,肾膀胱超声(RBUS),和麻醉识别相关文章。团队成员审查了各自的领域,以创建一套全面的指导方针。一位受邀的外部专家为验证目的审查了准则。结果:共审查54篇文献进行证据综合。构建了四个指南声明来指导诊断和成像,和七个声明来指导干预。然后使用指南来创建诊断和干预流程图,以便于使用。总之,RBUS应该是最初的诊断研究。如果诊断不确定性仍然存在,应进行非造影CT扫描.对于出现脓毒性阻塞结石的产科患者,应该实现紧急减压。如果局部因素允许,我们建议将输尿管支架置入术作为首选干预措施。结论:我们为妊娠期肾结石的管理提供了标准化的护理路径。我们的目标是标准化和简化泌尿科医师对这些复杂情况的临床管理。
Introduction: The management of nephrolithiasis during pregnancy can be stressful for urologists due to concerns for investigations and treatments that may pose risk of fetal harm, and unfamiliarity with optimal management of these complex patients. In response, we created multi-disciplinary evidence-based
guidelines to standardize the care for obstetric patients presenting with flank pain and suspicion for nephrolithiasis. Methods: A multi-disciplinary team involving Urology, Obstetric Anesthesiology, Obstetrics and Gynecology, Diagnostic Radiology, and Interventional Radiology from a single academic medical center was assembled. A PubMed search was performed using keywords of pregnancy/antepartum, nephrolithiasis/calculi/kidney stones, ureteroscopy, non-obstetric surgery, complications, preterm delivery, MRI, computerized tomography, renal bladder ultrasound (RBUS), and anesthesia to identify relevant articles. Team members reviewed their respective areas to create a comprehensive set of
guidelines. One invited external expert reviewed the
guidelines for validation purposes. Results: A total of 54 articles were reviewed for evidence synthesis. Four
guideline statements were constructed to guide diagnosis and imaging, and seven statements to guide intervention.
Guidelines were then used to create a diagnostic and intervention flowchart for ease of use. In summary, RBUS should be the initial diagnostic study. If diagnostic uncertainty still exists, a non-contrast CT scan should be obtained. For obstetric patients presenting with a septic obstructing stone, urgent decompression should be achieved. We recommend ureteral stent placement as the preferred intervention if local factors allow. Conclusions: We present a standardized care pathway for the management of nephrolithiasis during pregnancy. Our aim is to standardize and simplify the clinical management of these complex scenarios for urologists.