2260 AN INSTITUTIONAL REVIEW OF ANESTHETIC TIMES FOR URINARY STONES IN PREGNANT WOMEN

Abstract

INTRODUCTION AND OBJECTIVES: Management options for urolithiasis during pregnancy include trial of passage, temporizing ureteral stent or nephrostomy tube, and definitive treatment with ureteroscopy. Prior research suggests children can suffer adverse long term effects from exposure to medications used for general anesthesia. Specifically, anesthesia exposure greater than two hours or greater than two separate anesthesia exposures prior to the age of four years has been associated with the development of learning disabilities. The goal of this study is to compare the potential anesthesia risk to the fetus when temporizing stents are placed compared to definitive management with ureteroscopy. METHODS: We retrospectively reviewed the records of patients diagnosed with urolithiasis during pregnancy who underwent surgical intervention from 1997 to 2012. Patients were evaluated for a confirmed stone event, defined as a stone visualized on imaging or at surgery, along with management strategy including duration and frequency of anesthetic events. RESULTS: We identified 26 women with urolithiasis during pregnancy who met our inclusion criteria, of which 15 (58%) were managed with stents and 11 (42%) underwent ureteroscopic intervention. In the stent group 6 (40%) required multiple stent exchanges for a mean of 1.47 (range 1-3) anesthetic events and median anesthetic time of 70 minutes (range 29-208 min). Seven (47%) of the women managed with ureteral stent exchange were induced prior to term due to inability to tolerate the stent. Overall the ureteroscopy group had a mean of 1.18 anesthetic events (range 1-2) and 80 minutes (range 37-126 min) of anesthetic exposure. Two (18%) required two procedures either for infection or narrow ureter. None were induced early for pain. Comparing the two groups, there was no significant difference in number of events (p 0.208) or total anesthetic time (p 0.503). CONCLUSIONS: Ureteroscopic intervention appears safe and effective in treating acute stone events with equivalent if not less anesthetic exposure to the fetus compared to temporizing ureteral stents. Furthermore, early induction of labor due to pain is not a concern with ureteroscopy, as it has been shown to be with ureteral stenting. Our study provides further support to the role of definitive stone management instead of temporizing measures during pregnancy.