Spurious urinary calculosis in pregnancy.

Although the incidence of symptomatic urinary lithiasis in pregnancy is low, it is potentially serious in that it can cause serious renal damage, systemic sepsis or even endanger the pregnancy. Spurious calculosis in pregnancy must be a very unusual occurrence but does pose significant difficulties in diagnosis and management. A high index of clinical suspicion and analysis of calculi produced by the patient, should lead to the diagnosis. Case report: A 26 year old female was admitted in the 25th week of her second pregnancy with a history of severe right loin pain and vomiting. She was apyrexic and tender in the right iliac fossa. She passed a small calculus on the following day, which on analysis consisted of calcium oxalate. As the right iliac fossa pain did not subside after passage of the stone, a limited film intravenous urogram was performed and showed a normal pelvicalyceal system, mild dilatation of the right ureter, but no further stones. Because of continuing severe pain and the finding of ureteric dilatation, in the absence of infection, ureteroscopy was carried out to rule out the possibility of any remaining calculus. Though no stones were found in the ureter, a double-J-stent was inserted in anticipation of a radiolucent calculus in the kidney migrating and causing further pain. The patient's pain eased after this procedure and she was allowed home. She had to be readmitted three days later with severe recurrent right loin pain requiring frequent analgesics. The stent in the right ureter was assumed to be the cause of the pain and was removed, without any symptomatic relief. Unrelenting pain and apparent passage of further calculi necessitated frequent administration of opiate analgesics (pethidine) the cumulative amount exceeding 3.5 gm in 10 days. She was then commenced on an epidural infusion of 0.125% bupivicaine to reduce the need for parenteral opiates, which seemed to relieve her pain and she was again allowed home. She was admitted again seven weeks later (at 36 week gestation) with similar pain. She was recommenced on the epidural infusion of 0.125% bupivicaine with good effect. Caesarean section was carried out to facilitate further evaluation of urinary problems. She continued to complain of pain during the recovery phase and passed further calculi. Repeat urography, right retrograde pyelogram, CT scan and ureteroscopy failed to reveal evidence of any calculi.