Semirigid Ureteroscopy and Pneumatic Lithotripsy as Definitive Management of Obstructive Ureteral Calculi During Pregnancy

Abstract

To assess the results of semirigid ureteroscopy and intracorporeal pneumatic lithotripsy as a definitive treatment option for women presenting with obstructive ureteral calculi during pregnancy. A retrospective analysis was performed of 19 pregnant patients referred to our tertiary care center with ureteral obstruction necessitating surgical intervention from 1997 to 2007. The mean patient age was 22 years (range 18-27), and the mean gestation period was 20 weeks (range 14-34). Of the 19 patients, 21% were febrile, 32% had positive urine cultures, and 63% had pyuria and microscopic hematuria. Abdominal ultrasonography was the principle diagnostic test used. Six patients had history of renal stones before conception. The mean stone size was 11 mm, (range 8-18). Of the 19 patients, 58% had stones located in the proximal and 42% in the distal ureter. The stones were fragmented using a Swiss pneumatic lithoclast through a 6.9F/8F semirigid ureteroscope with the patient under general anesthesia. None of the patients underwent limited intravenous urography or computed tomography except for 1, who underwent plain x-ray of the kidneys, ureters, and bladder. All patients had obstruction due to the ureteral calculi, and 79% patients had complete fragmentation of the calculi by ureteroscopy as the primary treatment. Of the 19 patients, 63% required ureteral stent insertion per operatively. No complications related to the procedure itself or the general anesthesia were recorded, and all patients completed the full term of pregnancy. The results of our study have shown that semirigid ureteroscopy to diagnose ureteral calculi and treat them with intracorporeal pneumatic lithotripsy and ureteral stent insertion, as indicated, is the most efficient and definitive treatment modality in expectant women.