Introduction: Management of urinary stone disease in pregnancy is challenging as ionizing radiation and general anesthesia are associated with teratogenic risks. However, ureteroscopy for definitive stone management remains an accepted treatment strategy during pregnancy. Herein, we aimed to define current practice standards by investigating national use of imaging modalities and urologic procedures in pregnant women with urinary stone disease.
Methods: Using the IBM MarketScan national insurance claims database, we identified pregnant women with urinary stone disease and their corresponding gestational age between 2011-2016 by standardized ICD-9, ICD-10, CPT, and DRG code criteria. We grouped pregnancies by trimester using gestational age and then identified all women with an encounter for urinary stone or stone-related urologic procedure during their pregnancy. We abstracted demographic information as well as codes for stone procedures and imaging.
Results: We identified 14,298 pregnant women with urinary stone disease during the study period. Computed tomography (CT) was used in less than 0.1%, magnetic resonance imaging (MRI) in 2.8%, X-ray in 9%, and ultrasound in 99.8% of pregnant women with a urinary stone diagnosis (Figure 1). Procedural intervention during pregnancy was performed in 6.1% of the cohort: 1.3% ureteroscopy (URS), 4.2% ureteral stent placement, 0.6% percutaneous nephrostomy (PCN). Most cases of URS (n = 97) and stent placement (n = 367) were performed during the third trimester (Figure 2).
Conclusions: This large national cohort reveals the current imaging and procedural practice patterns for urinary stone disease during pregnancy and can provide a critical baseline as these practice patterns evolve in the future. Source of