Juliebø-Jones Patrick, Gauhar Vineet, De Smita, Ulvik Øyvind, Tanidir Yiloren, Akdogan Nebil, Aydi Cemil, Contreras Pablo, Frascheri Maria Florencia, Pizzarello Javier, Ragoori Deepak, Tzelves Lazaros, Gjengstø Peder, Æsøy Mathias Sørstrand, Hajj Albert El, Desouky Elsayed, Bautista-Perez-Gavilan Alejandro, Malkhasyan Vigen, Traxer Olivier, Beisland Christian, Somani Bhaskar K
Department of Urology, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Eur Urol Open Sci. 2025 May 24;76:65-70. doi: 10.1016/j.euros.2025.05.003. eCollection 2025 Jun.
In patients with stone disease during pregnancy, surgical management in the form of ureteroscopy (URS) can be indicated. However, there remains a relatively limited pool of published data. The objective was to perform a multicentre and international study evaluating the safety and outcomes of URS in pregnancy.
A retrospective study was performed across 12 tertiary endourology centres for patients undergoing URS during pregnancy over the past 10 yr. Data were collected on demographics, diagnostic imaging, operative findings, and intra- and postoperative complications. Follow-up data on stone-free rate (SFR) and pregnancy outcomes were also obtained.
A total of 146 females underwent URS, and the median age was 28 yr (interquartile range [IQR] 24-32). The majority were in the 2nd trimester (58%), were not presented (74%), and had the surgery performed by an endourologist (81%). Ultrasound was the most popular diagnostic imaging modality. Anaesthesia type was as follows: general (62%), spinal (23%), and sedation (15%). The negative URS rate was 48%. The median operative time was 35 min (IQR 35-45), and 77% were discharged within 24 h. The early and late complication rates were 11% and 2.8%, respectively. Regarding the former, there were two intensive care admissions (Clavien IV). In patients in whom a stone was found at URS, the SFR in terms of zero fragments was 65% and it was 78% for residual fragments of ≤2 mm based on postpartum imaging follow-up.
In the setting of a tertiary centre, URS can be performed safely during pregnancy with a low risk of major complications. Future studies are needed to investigate how the diagnostic algorithm can be improved to result in a lower rate of negative URS.
Managing kidney disease in pregnancy is recognised to be challenging as the surgeon must deliver safe care for both the mother and the unborn child. This is even more so the case when surgery to remove a stone is indicated. This study found that performing surgery using a method called ureteroscopy is safe, but it is recommended to be performed in an expert centre.
对于妊娠期患有结石病的患者，可考虑采用输尿管镜检查（URS）的手术方式进行治疗。然而，已发表的数据相对有限。本研究的目的是开展一项多中心国际研究，评估URS在妊娠期的安全性及治疗效果。
对过去10年期间在12个三级腔内泌尿外科中心接受URS治疗的妊娠期患者进行回顾性研究。收集患者的人口统计学资料、诊断性影像学检查结果、手术所见以及术中及术后并发症情况。同时获取结石清除率（SFR）及妊娠结局的随访数据。
共有146名女性接受了URS治疗，中位年龄为28岁（四分位间距[IQR]为24 - 32岁）。大多数患者处于妊娠中期（58%），未出现症状（74%），且手术由腔内泌尿外科医生实施（81%）。超声是最常用的诊断性影像学检查方式。麻醉方式如下：全身麻醉（62%）、脊髓麻醉（23%）和镇静麻醉（15%）。URS阴性率为48%。中位手术时间为35分钟（IQR为35 - 45分钟），77%的患者在24小时内出院。早期和晚期并发症发生率分别为11%和2.8%。就早期并发症而言，有2例患者入住重症监护病房（Clavien IV级）。在URS术中发现结石的患者中，根据产后影像学随访，结石零碎片清除率为65%，残留碎片≤2 mm的清除率为78%。
在三级中心环境下，妊娠期可安全进行URS，严重并发症风险较低。未来需要开展研究，以探讨如何改进诊断算法，降低URS阴性率。
妊娠期肾脏疾病的管理具有挑战性，因为外科医生必须为母亲和未出生的孩子提供安全的治疗。当需要进行结石清除手术时，情况更是如此。本研究发现，采用输尿管镜检查方法进行手术是安全的，但建议在专家中心进行。
