Scarpa R M, De Lisa A, Usai E
Dipartimento di Scienze Chirurgiche e Trapianti d'Organo, Università degli Studi di Cagliari, Italy.
J Urol. 1996 Mar;155(3):875-7.
There is still excessive debate as to the preferred diagnostic and therapeutic approach to urolithiasis in pregnancy. We report our experience with 15 pregnant patients with renoureteral colic marked by pain not responsive to analgesia, dilatation and fever. We focused on the usefulness of ureteroscopy with thin instruments and ultrasound in the diagnosis and treatment of ureteral stone and ureteral colic during pregnancy.
Between 1990 and 1993 we performed ureteroscopy and ureterolithotripsy on 15 pregnant patients 16 to 30 years old. Gestation time ranged from 20 to 34 weeks. All patients underwent ureteroscopy with thin rigid 7.0F or 9.5F ureteroscopes without dilation of the ureteral meatus. The use of ionizing radiation was avoided before, during and after the procedures. A stone was extracted from the lower third of the ureter in 2 cases, displaced into the kidney from the middle third of the ureter in 3, and fragmented with the pulsed dye laser in 3, the holmium:YAG laser in 3 and the ballistic lithotriptor in 2. Finally absence of ureteral calculi was confirmed in 2 cases. A double pigtail ureteral catheter was placed via echographic guidance in 14 cases to monitor curling of the pigtail in the renal pelvis, while in 1 a cylindrical ureteral catheter was used. In 5 cases no anesthesia was necessary, while 10 required neuroleptic analgesia.
There were no complications after the procedure. All pregnancies were full term.
Rigid ureteroscopy may be performed on the entire urinary tract even during advanced pregnancy. Stones may be fragmented, extracted or displaced and double pigtail ureteral catheters may be applied with only sonographic guidance, at times without use of anesthesia. The use of small instruments, such as the Gautier ureteroscope, that do not require dilation or any particular manipulation of the ureteral meatus seems to be essential together with an accurate ureteroscopic technique. In this manner it is possible to diagnose and treat ureteral calculi during pregnancy without resorting to ionizing radiation but using only ultrasound monitoring and ureteroscopy.
对于妊娠期尿路结石的首选诊断和治疗方法仍存在过多争议。我们报告了15例以疼痛对镇痛、扩张治疗和发热均无反应为特征的妊娠合并肾输尿管绞痛患者的治疗经验。我们重点关注了细径器械输尿管镜检查和超声在妊娠期输尿管结石及输尿管绞痛诊断和治疗中的作用。
1990年至1993年间，我们对15例年龄在16至30岁的妊娠患者进行了输尿管镜检查和输尿管碎石术。妊娠时间为20至34周。所有患者均使用7.0F或9.5F的硬质细径输尿管镜进行输尿管镜检查，未对输尿管口进行扩张。在手术前、手术期间和手术后均避免使用电离辐射。2例患者从输尿管下三分之一处取出结石，3例患者结石从输尿管中三分之一处移入肾脏，3例患者使用脉冲染料激光碎石，3例患者使用钬:钇铝石榴石激光碎石，2例患者使用弹道碎石器碎石。最后，2例患者输尿管结石消失得到确认。14例患者在超声引导下放置双猪尾输尿管导管以监测猪尾在肾盂内的卷曲情况，1例患者使用圆柱形输尿管导管。5例患者无需麻醉，10例患者需要神经安定镇痛。
术后无并发症发生。所有妊娠均足月分娩。
即使在妊娠晚期，也可对整个尿路进行硬质输尿管镜检查。结石可被击碎、取出或移位，双猪尾输尿管导管有时仅在超声引导下即可放置，甚至无需麻醉。使用如Gautier输尿管镜等无需扩张输尿管口或进行任何特殊操作的小型器械，以及精确的输尿管镜技术似乎至关重要。通过这种方式，在妊娠期无需借助电离辐射，仅使用超声监测和输尿管镜检查即可诊断和治疗输尿管结石。
