摘要
Background:The management of suspected kidney stone disease in pregnancy is challenging.In cases of persistent flank pain and where investigations may have rendered equivocal results,ureteroscopy(URS)is a recognized diagnostic and therapeutic intervention.This study aimed to investigate the safety and outcomes associated with performing URS during pregnancy,as the technique has evolved over the past 4 decades at our center.Materials and Methods:We performed a retrospective analysis of pregnant patients who underwent URS at our tertiary center between 1984 and 2022.Outcomes of interest included anesthetic approach,operative time,hospital stay,and complications.Results:Eighty-seven pregnant patients underwent 96 URS procedures,and 60%(n=57)of these procedures were performed during the third trimester.Overall,58%(n=56)of the procedures were achieved with local anesthesia and light sedation.During the most recent decade,the latter was successfully carried out in 97%of the procedures,with the remainder occurring under spinal anesthesia as per patient choice.Overall,57%(n=50)of the whole study group had ureteral calculi found at the time of surgery and in 88%(n=44)of these cases,fragmentation/extraction was performed.The remainder had insertion of ureteral stent with definitive clearance deferred until postpartum.Mean operative time and postprocedure hospital stay was 33 minutes(range,7-100 minutes)and 2.2 days(range,0-16 days),respectively.The overall intraoperative and postoperative complication rates were 2%and 11%,respectively.During the final decade,the latter improved to 6%and all adverse events were minor(ClavienⅠ/Ⅱ),with the exception of a single case.Regarding exit strategy,ureteral stent was placed in 42%(n=40)of the procedures,23%(n=22)had ureteral catheter inserted,and the remainder(35%,n=34)had none.Conclusions:Ureteroscopy can be safely performed during pregnancy using anesthetic approach with local anesthesia and light sedation.Development of a local protocol and multidisciplinary management algorithm are instrumental in enabling the delivery of such a service.
