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

IF 0.9 4区 医学 Q4 UROLOGY & NEPHROLOGY
Patrick Juliebø-Jones, Christian Beisland, Peder Gjengstø, Stephen Baug, Øyvind Ulvik
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引用次数: 8

Abstract

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 (Clavien I/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.

Abstract Image

妊娠期间输尿管镜检查:挪威一家三级中心40多年来的结果和经验教训。
背景:妊娠期疑似肾结石的处理具有挑战性。在持续的侧腹疼痛的情况下,如果调查结果模棱两可,输尿管镜检查(URS)是公认的诊断和治疗干预措施。在过去的40年里,我们中心的泌尿外科技术不断发展,本研究旨在调查妊娠期泌尿外科手术的安全性和相关结果。材料和方法:我们对1984年至2022年间在我们三级中心接受尿路手术的孕妇进行了回顾性分析。结果包括麻醉入路、手术时间、住院时间和并发症。结果:87例孕妇接受了96次URS手术,其中60% (n = 57)的手术在妊娠晚期进行。总的来说,58% (n = 56)的手术是在局部麻醉和轻度镇静下完成的。在最近的十年中,后者在97%的手术中成功进行,其余的手术根据患者的选择在脊髓麻醉下进行。总体而言,整个研究组中57% (n = 50)的患者在手术时发现输尿管结石,其中88% (n = 44)的患者进行了碎裂/拔除。其余患者则接受输尿管支架置入,最终清除延迟至产后。平均手术时间和术后住院时间分别为33分钟(范围7-100分钟)和2.2天(范围0-16天)。术中和术后并发症发生率分别为2%和11%。在最后十年中,后者提高到6%,所有不良事件都是轻微的(Clavien I/II),除了一个病例。关于退出策略,42% (n = 40)的手术放置了输尿管支架,23% (n = 22)的手术插入了输尿管导管,其余的(35%,n = 34)没有。结论:妊娠期输尿管镜检查采用局麻加轻镇静的麻醉入路是安全的。本地协议和多学科管理算法的开发有助于实现这种服务的交付。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Current Urology
Current Urology Medicine-Urology
CiteScore
2.30
自引率
0.00%
发文量
96
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