Deters Levi A, Belanger Gabriel, Shah Ojas, Pais Vernon M
Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
Clin Nephrol. 2013 Feb;79(2):118-23. doi: 10.5414/CN107654.
Management of renal colic and suspected urolithiasis in pregnancy remains a controversial topic. Competing concerns of operative fluoroscopy and prolonged duration of ureteral stent or nephrostomy tube fuel arguments for expectant management versus early surgical intervention. To address these concerns, we have offered ultrasound guided ureteroscopy for definitive management of suspected urolithiasis during pregnancy. We herein review our experience with this approach.
We performed a multi-center retrospective review of all pregnant patients undergoing ureteroscopy for suspected urolithiasis between 2008 and 2010. All pregnant patients who had undergone ultrasound guided ureteroscopy were included in this study. We evaluated presence of stone, stone size, operative time, stent duration, and post-operative course.
Seven pregnant patients underwent ultrasound guided ureteroscopy. The mean age was 28 years, mean gestation 24 weeks, with stone sizes ranging from 5 to 22 mm. All patients had undergone preoperative stenting. Ureteral stones were identified and removed in four patients. Post-operative imaging confirmed that there was no residual hydronephrosis or significant ipsilateral renal stone burden. Average stent duration was 7.3 days. Preterm labor occurred in one case.
In our experience, ultrasound guided ureteroscopy is a viable option in pregnancy to manage patients with suspected urolithiasis after failed expectant therapy. This method avoids fetal exposure to ionizing radiation, yet allows intraoperative radiographic monitoring. With this approach it is possible to render the patient stone free, obviating the need for ureteral stents for the duration of the pregnancy.
妊娠期肾绞痛和疑似尿路结石的管理仍然是一个有争议的话题。手术荧光镜检查以及输尿管支架或肾造瘘管放置时间延长所带来的相互矛盾的问题，引发了关于期待治疗与早期手术干预的争论。为了解决这些问题，我们采用超声引导下输尿管镜检查来明确处理妊娠期疑似尿路结石。在此，我们回顾我们采用这种方法的经验。
我们对2008年至2010年间所有因疑似尿路结石接受输尿管镜检查的孕妇进行了多中心回顾性研究。所有接受超声引导下输尿管镜检查的孕妇均纳入本研究。我们评估了结石的存在情况、结石大小、手术时间、支架放置时间以及术后过程。
七名孕妇接受了超声引导下输尿管镜检查。平均年龄为28岁，平均孕周为24周，结石大小在5至22毫米之间。所有患者术前均已放置支架。四名患者中发现并取出了输尿管结石。术后影像学检查证实没有残余肾积水或同侧明显的肾结石负荷。平均支架放置时间为7.3天。有一例发生了早产。
根据我们的经验，超声引导下输尿管镜检查是妊娠期处理期待治疗失败的疑似尿路结石患者的一种可行选择。这种方法避免了胎儿暴露于电离辐射，同时允许术中进行放射学监测。通过这种方法，可以使患者结石清除，从而在孕期无需放置输尿管支架。
