EP13.05: Case report: management of hydronephrosis in pregnancy in Tarakan General Hospital, Jakarta

Hydronephrosis is defined as the swelling or dilation of the renal pelvis and calyces accompanied by various degrees of renal parenchymal atrophy. This occurs due to obstruction of urine flow to the distal renal pelvis. The most common cause is the presence of stones in the urinary tract. Hydronephrosis in pregnancy occurs in 90 percent of normal pregnancies. Hydronephrosis typically resolves after pregnancy, although the renal pelvis and ureter may remain somewhat dilated. Hydronephrosis during pregnancy can worsen if accompanied by urinary tract stones. In the first case, Mrs. I, 42 years old, G4P3A0, at 22 weeks of pregnancy, complained of severe intermittent pain in the right flank, with a Visual Analog Scale (VAS) score of 8-9. Ultrasonography (USG) revealed grade 2 hydronephrosis and hydroureter caused by a stone. The patient underwent nephrostomy followed by placement of a right-sided Double J (DJ) stent. In the second case, Mrs. S, 37 years old, G3P2A0, at 26 weeks of pregnancy, presented with vaginal pain during urination and urine discoloured red, resembling blood, for 2 weeks prior, with a VAS score of 4-5. The patient was previously diagnosed with right-sided grade 2 hydronephrosis suspected of proximal ureterolithiasis, experiencing severe, continuous pain in the right flank, with a VAS score of 8-9. She underwent placement of a right-sided DJ stent and is scheduled for Ureterorenoscopy with Electrohydraulic Lithotripsy (EHL) and DJ stent replacement. In conclusion, early and accurate diagnosis with Ultrasound can improve the quality of life for pregnant women with hydronephrosis, especially when accompanied by urinary tract stones. If hydronephrosis is not accompanied by urinary tract stones, conservative therapy may suffice, but if stones and severe pain are present, surgical intervention is necessary.