Ureteroscopy during pregnancy under local anesthesia and light sedation:Technique and video

Ureteroscopy during pregnancy has become increasingly recognized as a safe intervention.Performing it under local anesthesia and light sedation reduces the risks associated with general or regional anesthesia,such as difficult airway scenarios,hypothermia,and hypotension.In addition,this approach reduces the total amount of fetal exposure to medications and anesthetic agents.Performing ureteroscopy in this manner requires a number of adjustments and modifications to the standard technique.This article provides a summary in a step-by-step format,as well as an accompanying video demonstration.

Ureteroscopy during pregnancy:Outcomes and lessons learned over 4 decades at a tertiary center in Norway

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.