Abstract
BackgroundSymptomatic ureteric stone during pregnancy can present a clinical challenge because of potential risks to both the mother and foetus. Ureteroscopy with laser and stone basket extraction represents an emerging strategy for definitive stone management in pregnancy, with minor complications. We aimed to evaluate the safety and efficacy of ureteroscopy with auxiliary procedures as a primary treatment for pregnant women with symptomatic ureteric stones who have failed conservative management.MethodsA prospective analysis was conducted in the Urology Department of Sulaymaniyah Teaching Hospital from June 2017 to November 2019 to evaluate pregnant patients who were treated with ureteroscopy and holmium laser lithotripsy for symptomatic ureteric stone.ResultsTwenty-six pregnant women aged between 18 and 34 years presented with renal colic (22 patients, 84.61%), severe hydronephrosis (3 patients, 11.53%), and progressive hydronephrosis (1 patient, 3.8%), suggesting ureteric stones. The diagnosis was established by abdominal ultrasonography. The mean stone size was 7.38 mm, ranging from 6–12 mm. The stones were located in the proximal ureter (n = 6, 23.1%), middle ureter (n = 0), and distal ureter (n = 20, 76.9%). Complete stone fragmentation was achieved in all patients. The overall procedure success rate was 87%, the stone-free rate was 23 out of 26 cases (88.46%), and no major obstetric or urologic complications were encountered.ConclusionsUreteric stone in pregnancy requires a high index of suspicion for a prompt and correct diagnosis. Ureteroscopy: flexible or semirigid endoscopy combined with holmium: YAG laser lithotripsy or with stone extraction are a preferred modality for the definitive treatment of symptomatic ureteric stone in pregnancy.
Highlights
Symptomatic ureteric stone during pregnancy can present a clinical challenge because of potential risks to both the mother and foetus
We evaluated 26 pregnant women who presented to our emergency department with an initial diagnosis of symptomatic ureteric stone and hydronephrosis that did not resolve despite conservative treatment during the follow-up period between June 2017 and November 2019
The inclusion criteria were as follows: pregnant women who were 16 years and above, failure to respond to conservative management for ureteric stones, all stages of pregnancy, all symptomatic ureteric stones, urosepsis, severe hydroureteronephrosis, renal impairment in a solitary kidney or bilateral disease; and persistent, intractable pain
Summary
Symptomatic ureteric stone during pregnancy can present a clinical challenge because of potential risks to both the mother and foetus. We aimed to evaluate the safety and efficacy of ureteroscopy with auxiliary procedures as a primary treatment for pregnant women with symptomatic ureteric stones who have failed conservative management. The incidence of physiologic hydronephrosis is as high as 90% on the right side and 67% on the left side during pregnancy. This typically resolves within one month after delivery, its laterality throughout pregnancy has shown no association with factors such as urinary tract problems or prior pregnancies [6]. Close follow-up should be performed during conservative treatment; any clinical suspension or impending complication may take the urologist into the stage of active management to relieve obstruction and preserve renal function
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