Treatment outcomes of semirigid ureterorenoscopy and intracorporeal lithotripsy in pregnant women with obstructive ureteral calculi

The purpose of the study is to evaluate the outcomes of semirigid ureterorenoscopy and intracorporeal lithotripsy as a definitive treatment in pregnant women with obstructive ureteral calculi. A retrospective analysis was performed of 16 pregnant patients referred to gynecology department with ureteral obstruction from 2007 to 2009. The mean age was 25 years, and mean gestation period was 30 weeks. Of the 16 patients; 50% had fever, 100% flank pain, 56% dysuria, 25% gross hematuria, 50% positive urine culture, and 75% pyuria and microscopic hematuria. Abdominal ultrasonography was the principle diagnostic test used. The mean stone size was 9.45 mm. Eleven of the 16 patients, 54% had stones located in the distal ureter and 46% proximal ureter. The stones were fragmented using a swiss pneumatic lithoclast through 9.5 F semirigid ureteroscope by 0.035 mm safety guidewire with the patient under general anesthesia. Eleven patients had obstruction due to the ureteral calculi. Eight of 11 patients had complete fragmentation of the calculi by ureteroscopy as a primary treatment. Push-back was performed in the other three patients. By applying Dj catheter, and performing eswl after giving birth, the patient became stone-free. Dj catheter was applied peroperative to all 16 patients. No complications were recorded, and all patients completed the full term of pregnancy. The results of our study have shown that semirigid ureteroscopy to diagnose ureteral calculi and treat them with intracorporeal pneumatic lithotripsy and ureteral stent insertion, as indicated, is the most efficient and definitive treatment modality in pregnant women.