Ureteroscopy in Pregnant Women for Ureteral Stone

Abstract

Introduction: The occurrence of urolithiasis in pregnancy represents a challenge in both diagnosis and treatment of this condition, because it presents risks not only to the mother but also to the fetus. Surgical treatment may be indicated for patients with infection, persistent pain, and obstruction of a solitary kidney. We present our experience on the management of pregnant patients with ureteral calculi and a review of the literature. Materials and Methods: The charts of 19 pregnant patients with obstructive ureteral calculi were retrospectively reviewed. Gestational age ranged from 13 to 33 weeks. In all patients, ureteral stone was diagnosed on abdominal ultrasound. In regard to localization, 15 calculi were in the distal ureter, 3 in the proximal ureter, and 1 in the interior of an ureterocele. Calculi size ranged from 6 to 10 mm (mean, 8 mm). The following criteria were used to indicate ureteroscopy: persistent pain with no improvement after clinical treatment, increase in renal dilation, or presence of uterine contractions. Nine patients (47.3%) were submitted to ureteroscopy. All calculi (100%) were removed with a stone basket extractor under continuous endoscopic vision. None of the calculi demanded the use of a lithotriptor. Results: Nine patients (47.3%) treated with clinical measurements presented no obstetric complications and spontaneous elimination of the calculi. Nine patients (47.3%) submitted to ureteroscopy had no surgical complications. There was remission of pain in all cases after ureteroscopy and ureteral catheter placement. Conclusion: The diagnosis and treatment of ureteral lithiasis in pregnant women present potential risks for the fetus and the mother. Conservative management is the first option, but ureteroscopy may be performed with safety and high success rates.

Urolithiasis in pregnancy: Survey in clinical epidemiology

“…Considering the conservative treatment (drug therapy) may cause potential hazards to mother and fetus [12] , in recent years many scholars have proposed that we can take active surgical intervention [13] in the treatment of symptomatic urinary calculi in pregnancy. Because gestational ureter has physiologic expansion, the passive expansion is not necessary when ureteroscopic treatment is performed.…”

Imaging for acute pelvic pain in pregnancy

“…The incidence of the symptomatic cases is estimated to be up to 1 in 2,000 pregnancies [99–103], and it is similar between pregnant and non-pregnant women. Renal colic is one of the most frequent non-obstetric causes for abdominal pain and subsequent hospitalisation during pregnancy [104, 105]. …”

Ureteroscopy during pregnancy

“…However, it should be noted that the literature detailing URS during pregnancy is limited, and entirely composed of single institution case series. [17–32]…”

“…As there has never been a randomized controlled trial comparing URS in pregnancy to ureteral stent or percutaneous nephrostomy placement, our knowledge of the risk of this practice is gained from an analysis of retrospective case series. A review of the published literature on the experience with URS of pregnant women finds a total of 16 published case series and one meta-analysis of 14 reports completed prior to the meta-analysis[417–32] [Table 1]. The aim of the meta-analysis was to define the safety of URS during pregnancy, by comparing complication rates of pregnant women undergoing URS to complication rates of the non-pregnant undergoing URS.…”