New Orleans—Managing stones in pregnant women can be challenging because many of the imaging technologies used to localize the stones, and the primary therapies to remove them or ease symptoms, may carry risks and/or side effects that might be amplified by the pregnancy.
A retrospective study of 28 patients conducted by Mayo Clinic researchers suggests that medical expulsive therapy employing tamsulosin (Flomax), an alpha-1-adrenergic receptor antagonist, can benefit pregnant women with minimal risk to either mother or child, as reported at the AUA annual meeting in New Orleans.
"Our study suggests that tamsulosin as medical expulsive therapy for symptomatic stones in pregnant patients is safe and may increase stone passage rates," George Bailey, MD, a urology resident at Mayo Clinic, Rochester, MN, told Urology Times.
"Larger cohorts will be helpful in further defining the role of tamsulosin for pregnant stone formers, but our initial experience indicates that the option of tamsulosin medical expulsive therapy should be part of the discussion when physicians counsel symptomatic pregnant stone formers, especially when symptoms are severe enough that they are considering things like stent placement, ureteroscopy, or percutaneous nephrostomy tube," said Dr. Bailey, who worked on the study with Amy Krambeck, MD, and colleagues.
To arrive at these conclusions, the Mayo team retrospectively identified 28 pregnant women with documented tamsulosin therapy for symptomatic urolithiasis. Of these women, 20 (71%) had urolithiasis documented by imaging and 23 (82%) had documented hydronephrosis. The median treatment period tamsulosin was 3 days (range, 1 to 110). Three patients (11%) were treated in their first trimester, 10 (36%) in their second, and 18 (67%) in their third trimester. Several patients had more than one course of therapy.
More on Stone Disease