Hellawell G O, Cowan N C, Holt S J, Mutch S J
Department of Urology, The Churchil Hospital, Oxford, UK.
BJU Int. 2002 Dec;90(9):801-8. doi: 10.1046/j.1464-410x.2002.03061.x.
To review the risks of placing double-pigtail stents during pregnancy in women presenting with loin pain associated with hydronephrosis.
A consecutive series of women presenting with loin pain and hydronephrosis in pregnancy were treated with double-pigtail ureteric stents. A flexible cystoscope was used to identify the ureteric orifice and to pass a guidewire into the renal pelvis under fluoroscopic guidance. Stents were placed using the exchange technique over a stiff guidewire. Procedures were carried out under none or limited sedoanalgesia. Screening times and radiation dose were recorded. Data were collected for the average uterine radiation dose from a variety of radiological procedures. Previous publications were reviewed to determine the lethal, teratogenic and carcinogenic risk to the developing fetus from radiation exposure.
Seven patients referred with symptomatic hydronephrosis during pregnancy were treated. The screening time during placement was minimized. The mean (range) uterus (i.e. fetal) dose was 0.40 (0.03-0.79) mGy. Most radiological procedures involve uterine doses of < 20 mGy, far below the 100 mGy that may result in fetal damage during periods of maximum radiosensitivity.
Minimized radiation exposure from a range of uroradiological procedures in pregnant women has limited fetal risk. The use of fluoroscopy for symptomatic hydronephrosis during pregnancy allows ureteric stents to be placed safely and reliably. The average excess risk to the fetus from this procedure is 1 in 43 000 of cancer induction and 1 in 100 000 of heritable disease, i.e. very small when compared with the natural incidence. Pregnancy should not exclude the use of appropriate diagnostic radiation exposure and urologists may conduct appropriate diagnostic and therapeutic procedures, taking care to limit X-ray exposure without fear of risk to the developing fetus.
回顾妊娠期间为出现与肾积水相关的腰痛的女性放置双猪尾支架的风险。
对一系列连续出现妊娠期间腰痛和肾积水的女性采用双猪尾输尿管支架进行治疗。使用可弯曲膀胱镜识别输尿管口，并在荧光透视引导下将导丝插入肾盂。通过交换技术在硬导丝上放置支架。手术在无镇静镇痛或有限镇静镇痛下进行。记录筛查时间和辐射剂量。收集各种放射学检查的平均子宫辐射剂量数据。查阅既往出版物以确定发育中的胎儿因辐射暴露而面临的致死、致畸和致癌风险。
对7例妊娠期间出现症状性肾积水的患者进行了治疗。放置过程中的筛查时间降至最短。子宫（即胎儿）平均剂量为0.40（0.03 - 0.79）毫戈瑞。大多数放射学检查的子宫剂量<20毫戈瑞，远低于在最大放射敏感性期间可能导致胎儿损伤的100毫戈瑞。
孕妇一系列泌尿放射学检查中辐射暴露降至最低，对胎儿的风险有限。妊娠期间对症状性肾积水使用荧光透视可安全可靠地放置输尿管支架。此操作对胎儿的平均额外风险为万分之二点三的致癌风险和十万分之一的遗传疾病风险，即与自然发生率相比非常小。妊娠不应排除使用适当的诊断性辐射暴露，泌尿外科医生可以进行适当的诊断和治疗操作，注意限制X线暴露，而不必担心对发育中的胎儿有风险。
