Ureteroscopy for Urolithiasis in Pregnancy: Outcomes of a Multicentre Study on Behalf of the European Association of Urology Section of Endourology

Abstract

Background and objective

In patients with stone disease during pregnancy, surgical management in the form of ureteroscopy (URS) can be indicated. However, there remains a relatively limited pool of published data. The objective was to perform a multicentre and international study evaluating the safety and outcomes of URS in pregnancy.

Methods

A retrospective study was performed across 12 tertiary endourology centres for patients undergoing URS during pregnancy over the past 10 yr. Data were collected on demographics, diagnostic imaging, operative findings, and intra- and postoperative complications. Follow-up data on stone-free rate (SFR) and pregnancy outcomes were also obtained.

Key findings and limitations

A total of 146 females underwent URS, and the median age was 28 yr (interquartile range [IQR] 24–32). The majority were in the 2nd trimester (58%), were not presented (74%), and had the surgery performed by an endourologist (81%). Ultrasound was the most popular diagnostic imaging modality. Anaesthesia type was as follows: general (62%), spinal (23%), and sedation (15%). The negative URS rate was 48%. The median operative time was 35 min (IQR 35–45), and 77% were discharged within 24 h. The early and late complication rates were 11% and 2.8%, respectively. Regarding the former, there were two intensive care admissions (Clavien IV). In patients in whom a stone was found at URS, the SFR in terms of zero fragments was 65% and it was 78% for residual fragments of ≤2 mm based on postpartum imaging follow-up.

Conclusions and clinical implications

In the setting of a tertiary centre, URS can be performed safely during pregnancy with a low risk of major complications. Future studies are needed to investigate how the diagnostic algorithm can be improved to result in a lower rate of negative URS.

Patient summary

Managing kidney disease in pregnancy is recognised to be challenging as the surgeon must deliver safe care for both the mother and the unborn child. This is even more so the case when surgery to remove a stone is indicated. This study found that performing surgery using a method called ureteroscopy is safe, but it is recommended to be performed in an expert centre.