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Re: Ob: Suspected nephrolithiasisFrom: Ronald Ainsworth (ainsron@sbcglobal.net)Tue Dec 26 12:21:16 2006
Follow and treat symptomatically. You've done what you need to do to rule out serious problems - infection, hydronephrosis, etc. What benefit would it have to do any other testing, such as an IVP or cystoscopy? Is there any evidence you would gain that you would use for therapeutic decisions? I don't think so. "Garry E. Siegel, M.D." <garrys@mindspring.com> wrote: 31 YO P0000 at 8 weeks. She is a CNM. She has a history of hematuria (dipstick and micro, not gross) predating pregnancy, and saw a urologist who suspected a small, asymptomatic stone, but no imaging done. Now, she is having daily unilateral flank pain radiating to her groin, and was in enough pain/nausea last night to be admitted for IVF. She is fearful of any meds for pain, and didn't require an anti-emetic. Her hope is that IVF over time will help with passage of the suspected stone. Her exam is benign, CBC and metabolic panels normal, and normal u/a with a culture pending. Today's renal ultrasound is totally negative, and she has a viable 7w5d gestation. The radiologist says that any stone big enough to warrant consideration for extraction would result in hydronephrosis, and there is none. In speaking with the urologist, we kicked around a limited IVP (scout, and one or two post injection shots) versus simply using pain meds/anti-emetics; the patient is torn and really wants to do nothing. I have advised taking meds as needed and delaying imaging until later (12 weeks, and only if symptomatic) for her peace of mind. I'm really not too worried about a limited IVP here--and I believe Ashley had a nice paper from around 1995 regarding radiation in pregnancy. Both the urologist and radiologist are hesitant, and the urologist was worried about a cystoscopy (if needed for extraction) causing an abortion. I've really not ever seen problems with indicated imaging studies such as a limited IVP, or cystoscopy--realizing that the numbers of bad outcomes would be exceedingly small, and the number of cases I've seen isn't huge. My gut says take meds prn and image at some point--as per above. Any thoughs? Garry
-- Garry E. Siegel, M.D. Private Practice Roswell, GA
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