Başkent University Faculty of Medicine, Department of Urology, Alanya Practice and Research Center, Alanya, Turkey.
Urology. 2012 Nov;80(5):1011-4. doi: 10.1016/j.urology.2012.04.039. Epub 2012 Jun 13.
To review our experiences with management of symptomatic ureteral calculi complicating pregnancy.
Between January 2001 and December 2011, 57 pregnant women were treated for symptomatic ureteral stones. The medical records of these patients were reviewed retrospectively.
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.
When conservative treatment fails, ureteroscopy is an effective and safe therapeutic option in symptomatic ureteral calculi complicating pregnancy.
回顾妊娠合并症状性输尿管结石的治疗经验。
2001 年 1 月至 2011 年 12 月，57 例妊娠合并症状性输尿管结石患者接受了治疗。回顾性分析这些患者的病历资料。
患者的平均年龄为 24 岁（17-37 岁），就诊时的孕周为 26 周（12-38 周）。大多数病例（60%）发生在妊娠晚期。最常见的症状是腰痛（90%）。超声检查是确诊的初始检查。经保守治疗，13 例（22.8%）结石自行排出。10 例（17.5%）患者在妊娠结束前，症状缓解但结石未自行排出。34 例（59.6%）患者因持续疼痛和/或输尿管梗阻需要有创治疗。29 例患者通过输尿管镜成功治疗输尿管结石。结石通过气压弹道碎石或取石钳取出。5 例患者由于结石未触及或移位，仅在输尿管镜下置入双 J 支架。大多数患者（58.8%）为下段输尿管结石。取出的结石平均大小为 7mm（4-13mm）。5 例患者出现输尿管水肿、轻度输尿管裂伤或出血等轻微并发症。3 例患者发生尿路感染，3 例患者抱怨支架引起的膀胱刺激症状；1 例患者在术后出现子宫收缩，但在任何情况下均未观察到严重的产科或泌尿科并发症。
对于保守治疗无效的患者，输尿管镜是治疗妊娠合并症状性输尿管结石的有效且安全的选择。
