Ureteroscopy - First-line Treatment Alternative in Ureteral Calculi During Pregnancy

Background: Urolithiasis during pregnancy is not common butremains both a diagnostic and treatment challenge. The aim ofthe study was to assess the ureteroscopy results as definitivetreatment option in pregnant women with obstructive ureteralcalculi.Material & Methods: Between 2006 and 2012, in our clinicaldepartment, 54 pregnant women underwent active treatmentfor ureteral lithiasis and in 38 of these cases ureteroscopy wasapplied as definitive therapy. The average patients’ age was27.2 years (range 20-37 years) and the gestation period variedbetween 9 to 35 weeks. Flank pain was the commonpresenting symptom (52 54 cases), 4 women had associatedfever, and 14 complained of irritative voiding symptoms.Semirigid ureteroscopy was the first choice alternative for thefirst 2 trimesters while flexible approach or double J indwellingwere preferred for patients in the last trimester of pregnancy.Results: Semirigid ureteroscopy allowed stone treatment in28 32 cases. In 17 patients, calculi fragmentation usingHo:YAG laser or ballistic lithotripsy were performed, while in11 cases, the stone was removed intact. Minor intraoperativecomplications were encountered in 5 patients. Postoperatively,urinary tract infection developed in 4 patients, renal colic in 2and prolonged hematuria in one case, while 4 patientscomplained of stent-induced bladder irritation. Flexibleureteroscopy was successfully completed in all patients. Therewere no complications related to this procedure. All pregnancieswere carried out to full term.Conclusions: Ureteroscopy may be considered a safe andeffective first-line definitive therapeutic option in pregnantpatients requiring intervention for ureteral stone.

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