Ep. 43 Urolithiasis in Pregnancy: Balancing Risks and Management with Dr. Alan Desai

In this episode, Dr. Suzette Sutherland and Dr. Alana Desai from the University of Washington discuss the management of urinary tract stones in pregnant patients, considerations for ureteroscopy, and consequences of radiation exposure in the fetus. First, the doctors underscore the importance of ultrasound as the first line imaging modality to minimize fetal exposure to radiation. Dr. Sutherland and Dr. Desai also delve into nausea and pain management options, recommended diets for prevention of stone formation during pregnancy, and the necessity of involving a multidisciplinary team in such cases. The episode concludes with a remarkable case study from Dr. Desai’s experience. --- SHOW NOTES 00:00 - Introduction 02:06 - Incidence and Risk Factors of Kidney Stones in Pregnancy 03:29 - Physiological Changes and Stone Formation in Pregnancy 07:04 - Diagnosing Kidney Stones in Pregnancy 13:08 - Expectant Management vs. Intervention 14:41 - Managing Pain and Nausea in Pregnant Patients with Kidney Stones 17:13 - Decompression Methods for Kidney Stones in Pregnancy 23:13 - Ureteroscopy as a Preferred Intervention 26:05 - Case Description from Dr. Desai 30:04 - Considerations for Ureteroscopy in Pregnant Patients 31:14 - Preventing Kidney Stones in Pregnancy --- RESOURCES Lyon, M., Sun, A., Shah, A., Llarena, N., Dempster, C., Sivalingam, S., Calle, J., Gadani, S., Zampini, A., & De, S. (2023). Comparison of Radiation Exposure for Pregnant Patients Requiring Intervention for Suspected Obstructing Nephrolithiasis. Urology, 182, 61–66. https://doi.org/10.1016/j.urology.2023.09.023 Thongprayoon, C., Vaughan, L. E., Chewcharat, A., Kattah, A. G., Enders, F. T., Kumar, R., Lieske, J. C., Pais, V. M., Garovic, V. D., & Rule, A. D. (2021). Risk of Symptomatic Kidney Stones During and After Pregnancy. American journal of kidney diseases : the official journal of the National Kidney Foundation, 78(3), 409–417. https://doi.org/10.1053/j.ajkd.2021.01.008