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Ultrasound Guided Ureteroscopy in Pregnancy
Levi Deters, MD1, Gabriel Belanger, MD2, Ojas Shah, MD3, Vernon Pais, Jr., MD1.
1Dartmouth Hitchcock Medical Center, Lebanon, NH, USA, 2Maine Medical Center, Portland, ME, USA, 3NYU Langdone Medical Center, New York City, NY, USA.

BACKGROUND:
Management of renal colic and suspected urolithiasis in pregnancy remains a controversial topic. Competing concerns of operative fluoroscopy and prolonged duration of ureteral stent or nephrostomy tube fuel arguments for expectant management versus early surgical intervention. To address these concerns, we have offered ultrasound guided ureteroscopy for definitive management of suspected urolithiasis during pregnancy and herein review our experience with this approach.
METHODS:
We performed a multi-center retrospective review of all pregnant patients undergoing ureteroscopy for suspected urolithiasis between 2008-2010. All pregnant patients who had undergone ultrasound guided ureteroscopy were included in this study. We evaluated presence of stone, stone size, operative time, stent duration, and post operative course.
RESULTS:
Seven pregnant patients underwent ultrasound guided ureteroscopy, mean age 28 years, mean gestation 24 weeks with stone sizes ranging from 5-22mm. All patients had undergone preoperative stenting. Ureteral stones were identified and removed in four patients. Post operative imaging confirmed that there was no residual hydronephrosis or significant ipsilateral renal stone burden. Average stent duration was 7.3 days. Preterm labor occurred in one case.
CONCLUSIONS:
In our experience, ultrasound guided ureteroscopy is a plausible option in pregnancy to manage patients with suspected urolithiasis after failed expectant therapy. This method avoids fetal exposure to ionizing radiation, yet allows intraoperative radiographic monitoring. With this approach it is possible to render the patient stone free, obviating the need for ureteral stents for the duration of the pregnancy.


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