Ureteroscopy pp 373-381 | Cite as

Ureteroscopic Management of Stones During Pregnancy

  • Vernon M. PaisJr.Email author
Part of the Current Clinical Urology book series (CCU)


The management of stones during pregnancy can be a daunting undertaking for both patient and provider. Ureteroscopy is increasingly utilized as a definitive therapy in this setting. However, the risks—both real and perceived—make this an expedition that can be fraught with anxiety for all parties involved.

Therefore, a review of the background, potential modifications of approach, and fine points of technique is provided. These, and a discussion of potential pitfalls, are addressed in this chapter.


Renal Pelvis Calcium Oxalate Ureteral Stone Renal Colic Expectant Management 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Rodriguez PN, Klein AS. Management of urolithiasis during pregnancy. Surg Gyn Obstet. 1988;166: 103–6.Google Scholar
  2. 2.
    Lewis DF, Robichaux AG, Jaekle RK, et al. Urolithiasis in pregnancy-diagnosis, management, and pregnancy outcome. J Reprod Med. 2003;48:28–32.PubMedGoogle Scholar
  3. 3.
    Swartz MA, Lydon-Rochelle MT, Simon D, et al. Admission for nephrolithiasis in pregnancy and risk of adverse birth outcomes. Obstet Gynecol. 2007;109: 1099–104.CrossRefPubMedGoogle Scholar
  4. 4.
    Stothers L, Lee LM. Renal colic in pregnancy. J Urol. 1992;148:1383–7.PubMedGoogle Scholar
  5. 5.
    Coe FL, Parks JH, Lindheimer MD. Nephrolithiasis during pregnancy. N Engl J Med. 1978;298:324–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Mhuireachtaigh RN, O’Gorman DA. Anesthesia in pregnant patients for nonobstetric surgery. J Clin Anesth. 2006;18:60–6.CrossRefGoogle Scholar
  7. 7.
    Loughlin KR. Management of urologic problems during pregnancy. Urology. 1994;44:159–69.CrossRefPubMedGoogle Scholar
  8. 8.
    Smith CL, Kristensen MD, Abraham PA. An evaluation of the physiochemical risk for renal stone disease during pregnancy. Clin Nephrol. 2001;55:205–11.PubMedGoogle Scholar
  9. 9.
    Maikranz P, Holley JL, Parks JH, et al. Gestational hypercalciuria causes pathological urine calcium oxalate supersaturations. Kidney Int. 1989;36:108–13.CrossRefPubMedGoogle Scholar
  10. 10.
    Maikranz P, Lindheimer M, Coe F. Nephrolithiasis in pregnancy. Baillieres Clin Obstet Gynaecol. 1994;8(2):375–86.CrossRefPubMedGoogle Scholar
  11. 11.
    Yatzidis H. Gestational urinary hyperthiosulfaturia protects hypercalciuric normal pregnant women from nephrolithiasis. Int Urol Nephrol. 2004;36: 445–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Parulkar BG, Hopkins TB, Wollin MR, et al. Renal colic during pregnancy: a case for conservative treatment. J Urol. 1998;159:365–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Travassos M, Amselem I, Filho NS, Miguel M, Sakai A, Consolmagno H, Nogueira M, Fugita O. Ureteroscopy in pregnant women for ureteral stone. J Endourol. 2009;23(3):405–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Burgess KL, Gettman MT, Rangel LJ, et al. Diagnosis of urolithiasis and rate of spontaneous passage during pregnancy. J Urol. 2011;186:2280–4.CrossRefPubMedGoogle Scholar
  15. 15.
    Preminger GM, Tiselius HG, Assimos DG, et al. Guideline for the management of ureteral calculi. J Urol. 2007;178:2418–34.CrossRefPubMedGoogle Scholar
  16. 16.
    Semins MJ, Matlaga BR. Management of stone disease in pregnancy. Curr Opin Urol. 2010;20(2):174–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Khoo L, Anson K, Patel U. Success and short-term complication rates of percutaneous nephrostomy during pregnancy. J Vasc Interv Radiol. 2004;15:1469.CrossRefPubMedGoogle Scholar
  18. 18.
    ACOG Committee on Obstetric Practice. ACOG Committee opinion no. 474. Non-obstetric surgery during pregnancy. Obstet Gynecol. 2011;117:420–1.CrossRefGoogle Scholar
  19. 19.
    Rosen MA. Management of anesthesia for the pregnant surgical patient. Anesthesiology. 1999;91:1159–63.CrossRefPubMedGoogle Scholar
  20. 20.
    Wolf JS, Bennett CJ, Dmochowski RR, et al. Best practice policy statement on urologic surgery antibiotic prophylaxis. J Urol. 2008;179:1379–90.CrossRefPubMedGoogle Scholar
  21. 21.
    Bar-Oz B, Moretti ME, Boskovic R, et al. The safety of quinolones-a meta-analysis of pregnancy outcomes. Eur J Obstet Gynecol Reprod Biol. 2009;143:75–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Davis SM, Branch DW. Thromboprophylaxis in pregnancy: who and how. Obstet Gynecol Clin North Am. 2010;37:333–43.CrossRefPubMedGoogle Scholar
  23. 23.
    Forrest JB, Clemens JQ, Finamore P, et al. AUA best practice statement for the prevention of deep venous thrombosis in patients undergoing urologic surgery. J Urol. 2009;181:1170–7.CrossRefPubMedGoogle Scholar
  24. 24.
    ACOG Committee on Obstetric Practice. ACOG Committee opinion no. 299. Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol. 2004;104:647–51.CrossRefGoogle Scholar
  25. 25.
    Loughlin KR. Urologic radiology during pregnancy. Urol Clin North Am. 2007;34:23–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Lifshitz DA, Lingeman JE. Ureteroscopy as a first line intervention for ureteral calculi in pregnancy. J Endourol. 2002;16:19.CrossRefPubMedGoogle Scholar
  27. 27.
    Cocuzza M, Colombo JR, Lopes RI, et al. Use of Inverted fluoroscope’s c-arm during endoscopic treatment of urinary tract obstruction in pregnancy: a practicable solution to cut radiation. Urology. 2010;75: 1505–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Watterson JD, Girvan AR, Beiko DT, et al. Ureteroscopy and holmium: yag laser lithotripsy: an emerging definitive management strategy for symptomatic ureteral calculi in pregnancy. Urology. 2002;60:383–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Tawfiek ER. Ureteroscopy during pregnancy with follow-the-wire technique. Afr J Urol. 2009;15: 245–9.CrossRefGoogle Scholar
  30. 30.
    Clayman M, Uribe CA, Eichel L, et al. Comparison of guidewires in urology. Which, when, and why? J Urol. 2004;171:2146–50.CrossRefPubMedGoogle Scholar
  31. 31.
    Bakke A, Ulvik NM. Ureterorenoscopy in pregnancy. Scand J Urol Nephrol Suppl. 1988;110:243–4.PubMedGoogle Scholar
  32. 32.
    Polat F, Suleyman Y, Kirac M, et al. Treatment outcomes of semi rigid ureterorenoscopy and intracorporeal lithotripsy in pregnant women with obstructive ureteral calculi. Urol Res. 2011;39:487–90.CrossRefPubMedGoogle Scholar
  33. 33.
    Rana AM, Aquil S, Khawaja AM. Semirigid ureteroscopy and pneumatic lithotripsy as definitive management of obstructive ureteral calculi during pregnancy. Urology. 2009;73:964–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Marguet CG, Sung JC, Springhart WP, et al. In vitro comparison of stone retropulsion and fragmentation of the frequency doubled, double pulse nd:yag laser and holmium: yag laser. J Urol. 2005;173: 1797–800.CrossRefPubMedGoogle Scholar
  35. 35.
    Akpinar H, Tufek I, Alici B, Kural AR. Ureteroscopy and holmium laser lithotripsy in pregnancy: stents must be used postoperatively. J Endourol. 2006;20: 107–10.CrossRefPubMedGoogle Scholar
  36. 36.
    Semins MJ, Trock BJ, Matlaga BR. The safety of ureteroscopy during pregnancy: a systematic review and meta-analysis. J Urol. 2009;181(1):139–43.CrossRefPubMedGoogle Scholar
  37. 37.
    Johnson EB, Krambeck AE, White WM, et al. Obstetric complications of ureteroscopy during pregnancy. J Urol. 2012;188(1):151–4.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Section of Urology, Department of SurgeryGeisel School of Medicine at DartmouthLebanonUSA

Personalised recommendations