Ureteroscopy during pregnancy: Outcomes and lessons learned over 4 decades at a tertiary center in Norway

Abstract

BackgroundThe management of suspected kidney stone disease in pregnancy is challenging. In cases of persistent flank pain and where investigations may have rendered equivocal results, ureteroscopy (URS) is a recognized diagnostic and therapeutic intervention. This study aimed to investigate the safety and outcomes associated with performing URS during pregnancy, as the technique has evolved over the past 4 decades at our center.Materials and MethodsWe performed a retrospective analysis of pregnant patients who underwent URS at our tertiary center between 1984 and 2022. Outcomes of interest included anesthetic approach, operative time, hospital stay, and complications.ResultsEighty-seven pregnant patients underwent 96 URS procedures, and 60% (n = 57) of these procedures were performed during the third trimester. Overall, 58% (n = 56) of the procedures were achieved with local anesthesia and light sedation. During the most recent decade, the latter was successfully carried out in 97% of the procedures, with the remainder occurring under spinal anesthesia as per patient choice. Overall, 57% (n = 50) of the whole study group had ureteral calculi found at the time of surgery and in 88% (n = 44) of these cases, fragmentation/extraction was performed. The remainder had insertion of ureteral stent with definitive clearance deferred until postpartum. Mean operative time and postprocedure hospital stay was 33 minutes (range, 7–100 minutes) and 2.2 days (range, 0–16 days), respectively. The overall intraoperative and postoperative complication rates were 2% and 11%, respectively. During the final decade, the latter improved to 6% and all adverse events were minor (Clavien I/II), with the exception of a single case. Regarding exit strategy, ureteral stent was placed in 42% (n = 40) of the procedures, 23% (n = 22) had ureteral catheter inserted, and the remainder (35%, n = 34) had none.ConclusionsUreteroscopy can be safely performed during pregnancy using anesthetic approach with local anesthesia and light sedation. Development of a local protocol and multidisciplinary management algorithm are instrumental in enabling the delivery of such a service.

Innovations in Kidney Stone Removal

“…Improved ureteroscopes and vision have also improved the management of upper tract tumors. 82 , 83 While it also allows the treatment of high-risk patient groups such as in pediatric patients and during pregnancy, 84 , 85 perhaps future studies should also consider the cost and quality of life aspects of stone treatment. 86 , 87 …”

Single use flexible ureteroscopes: Current status and future directions

“…This includes the 4.9 Fr tapered tip of the Olympus URF‐P7. The smaller size has been found to translate to clinical advantages especially for negotiating access to the ureteric orifice in more challenging anatomy such as children and pregnancy 58,59 . That model also has a smooth bullet shape to it that is lacking in SU models.…”

“…This includes the introduction of digital technology, optic systems and a wide selection of accessories that can be used 4,5 . As such, the selection of patient groups that can be safely treated has been expanded and now includes patients at the extremes of age, pregnancy and complex anatomy such as renal transplants 6–8 . Single use (SU) flexible ureteroscopes (also referred to as ‘disposable’) are another development that became commercially available in October 2015 9 .…”

Management of urolithiasis in pregnancy

“…While performing URS after the first trimester is preferred to minimize the risks associated with surgery and anesthesia, a retrospective study from a tertiary center demonstrated the absence of intraoperative or postoperative obstetric complications following URS performed in the first trimester. [48] The same study showed that URS may be performed safely during pregnancy with local anesthesia (2% lidocaine gel) and light sedation, which offers a useful alternative for patients in whom spinal anesthesia cannot be tolerated or is contraindicated and for patients who do not want to undergo general anaesthesia. [48]…”

“…[48] The same study showed that URS may be performed safely during pregnancy with local anesthesia (2% lidocaine gel) and light sedation, which offers a useful alternative for patients in whom spinal anesthesia cannot be tolerated or is contraindicated and for patients who do not want to undergo general anaesthesia. [48]…”