Management of kidney stones in pregnancy: A worldwide survey of practice patterns

Introduction Kidney stones is pregnant is not a common emergency, but it is one that is extremely challenging to manage. There exists no previous survey, which maps the different practice patterns adopted. Our aim was to deliver a survey to evaluate the current status of practice patterns across different parts of the world regarding the management of stone disease in pregnancy. Methods Through an iterative process, 19-item survey was devised. This contained the following five sections: 1. Demographics 2. General items 3. Diagnosis & Imaging 4. Initial management 5. Surgery. It was disseminated via social media and email chains. Results 355 responses were collected and the majority (66.2%) reported no established hospital protocol for stones in pregnancy. Ultrasound was the most popular first line imaging choice (89.9%) but 8% would choose non contrast CT. The latter was also chosen as second line choicer in 34.6% as opposed to MRI. A large proportion (42.5%) had requested CT in pregnancy previously. With equivocal US results, only 19.4% would proceed to ureteroscopy but 40.9% would opt for CT. 24-48 hours was the most popular (37.6%) time period to observe before surgical intervention. Ureteral stent and nephrostomy were regarded as equally effeftive.6 weeks was most popular frequency for an exchange. Most do not use fetal heart rate monitoring intra-operatively. 3.94% had previously performed PCNL during pregnancy. Conclusion Practice patterns vary widely for suspected kidney stones in pregnancy and use of CT appears increasingly popular. This includes when faced with equivocal ultrasound results and instead of proceeding to ureteroscopy. Most hospitals lack an established management protocol for this scenario.