OBJECTIVE: It is difficult to reach a diagnosis of symptomatic hydronephrosis in pregnancy.We reviewed the medical records of the past 5 years in order to determine an efficient and safe way to resolve this problem.MATERIALS AND METHODS: From January 1997 to June 2002, there were 30pregnant women in our hospital with symptomatic hydronephrosis. All patients were initially treated conservatively (positioning, analgesics, and antibiotics). Either double J (DJ) stent insertion, ureterorenoscopy,
or percutaneous nephrostomy was applied if symptoms persisted.RESULTS: During the course of pregnancy, none of the patients underwent a radiographic study. Eighteen cases were only treated conservatively. The remaining 12 cases reported persistent symptoms and were treated with DJ stent insertion by cystoscopy. However, DJ insertion failure by cystoscopy occurred in 4 patients: 2 underwent ureterorenoscopic lithotripsy and DJ insertion due to stone impaction and the other 2 underwent DJ insertion by ureterorenoscopy (URS). In the latter group, URS failed in 1 patient, and percutaneous nephrostomy insertion was subsequently performed.CONCLUSIONS: Most cases of symptomatic hydronephrosis during pregnancy can be resolved by conservative treatment. Radiographic studies are not absolutely indicated and can be
substituted with ultrasonographic study. Under local anesthesia, double J stent insertion is safe and efficient. Spinal anesthesia can be used in complicated cases.