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Hoşcan MB et al, 2012: Management of Symptomatic Ureteral Calculi Complicating Pregnancy

Hoşcan MB, Ekinci M, Tunçkıran A, Oksay T, Ozorak A, Ozkardeş H
Department of Urology, GATA Haydarpasa Teaching Hospital, 34668, Uskudar, Istanbul, Turkey


Abstract

OBJECTIVE: To review our experiences with management of symptomatic ureteral calculi complicating pregnancy.

METHODS: Between January 2001 and December 2011, 57 pregnant women were treated for symptomatic ureteral stones. The medical records of these patients were reviewed retrospectively.

RESULTS: The mean patient age was 24 (range 17-37) years and gestational age at presentation was 26 weeks (range 12-38). Most of the cases (60%) occurred in the third trimester. Flank pain was the most common presenting symptom (90%). Ultrasonography was the initial test confirming diagnosis. With conservative management, spontaneous passing of stones was noted in 13 cases (22.8%). In 10 patients (17.5%), symptomatic relief occurred without spontaneous passing of stones until the end of pregnancy. Invasive management was required in 34 patients (59.6%) because of persistent pain and/or ureteral obstruction. In 29 patients, ureteral calculi were treated successfully by ureteroscopy. Stones were extracted by pneumatic lithotripsy or forceps. In 5 patients, only double-J stent was inserted during ureteroscopy as a result of unreached or migrated stone. The majority of patients (58.8%) had lower ureteric calculi. The mean size of the stones retrieved was 7 mm (range 4-13 mm). Minor complications like ureteric edema, mild ureteric laceration, or bleeding were seen in 5 patients. Three patients had a urinary tract infection and 3 complained of stent-induced bladder irritation; uterine contraction was observed after the procedure in 1 patient, but no serious obstetric or urologic complications were observed in any case.

CONCLUSION: When conservative treatment fails, ureteroscopy is an effective and safe therapeutic option in symptomatic ureteral calculi complicating pregnancy.

Copyright © 2012 Elsevier Inc. All rights reserved.
Urology. 2012 Nov;80(5):1011-4. doi: 10.1016/j.urology.2012.04.039. Epub 2012 Jun 13
PMID: 22698475 [PubMed - as supplied by publisher]

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Comments 1

Hans-Göran Tiselius on Monday, 20 February 2012 07:35

Inasmuch as ESWL is excluded as treatment alternative for stones in pregnant women (absolute contraindication), it might be worthwhile to consider the results recorded in 57 pregnant women with stones. Accordingly spontaneous passage occurred in 13 (23%). In another 10 women (18%) symptomatic treatment until the end of pregnancy was successful. Invasive treatment was carried out in 34 (60%) patients; URS in 29 and just stenting in 5. It is obvious that with improved endoscopic technology and in expert hands a more generous attitude to URS has to a large extent replaced the previous routine to insert nephrostomy catheters. Despite this progress conservative treatment always should be the primary therapeutic approach.

Hans-Göran Tiselius

Inasmuch as ESWL is excluded as treatment alternative for stones in pregnant women (absolute contraindication), it might be worthwhile to consider the results recorded in 57 pregnant women with stones. Accordingly spontaneous passage occurred in 13 (23%). In another 10 women (18%) symptomatic treatment until the end of pregnancy was successful. Invasive treatment was carried out in 34 (60%) patients; URS in 29 and just stenting in 5. It is obvious that with improved endoscopic technology and in expert hands a more generous attitude to URS has to a large extent replaced the previous routine to insert nephrostomy catheters. Despite this progress conservative treatment always should be the primary therapeutic approach. Hans-Göran Tiselius
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