Navigating the Complexities of Symptomatic Hydronephrosis in Pregnancy.

Autor:	Khalabazyane B; Urology, Royal Bournemouth Hospital, Bournemouth, GBR., David R; Urology, Great Western Hospital National Health Service (NHS) Foundation Trust, Swindon, GBR., Rashid R; General and Colorectal Surgery, Arrowe Park Hospital, Wirral, GBR., Philips J; Urology, Royal Bournemouth Hospital, Bournemouth, GBR.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 May 28; Vol. 16 (5), pp. e61240. Date of Electronic Publication: 2024 May 28 (Print Publication: 2024).
DOI:	10.7759/cureus.61240
Abstrakt:	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. Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Khalabazyane et al.)
Databáze:	MEDLINE
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