Diagnosis and operative intervention for problematic ureteral calculi during pregnancy

Objective: To review the management of problematic ureteral calculi in pregnancy and to compare efficacy among 3 treatments: ureteroscopic lithotripsy, ureteral stent insertion, and percutaneous nephrostomy.

Methods: In a retrospective study at Sheng Jing Hospital, Shenyang, China, data were analyzed from 54 consecutive pregnant patients who required medical intervention for urolithiasis between April 2001 and July 2012. The patients were divided into 3 groups based on whether they had ureteroscopic lithotripsy (group 1, n=21), nephrostomy (group 2, n=16), or ureteral stent insertion (group 3, n=17). Statistical significance was evaluated by Student t test and χ(2) test.

Results: In group 1, 18 of 21 patients had complete calculi fragmentation. In group 2, nephrostomy was carried out successfully for all 16 patients. The insertion of a ureteral stent was possible for 12 of 17 patients in group 3. The ureteroscopic lithotripsy procedure took longer than the other 2 procedures (P<0.005). Patients in the stent insertion group had the highest rate of complications (52.9%) and lowest rate of success (70.6%).

Conclusion: Ureteroscopic lithotripsy was found to be an effective intervention during pregnancy. However, the choice of treatment depends on the individual situation.