Ureteroscopy during pregnancy with follow-the-wire technique

Abstract

Purpose

To present our experience with ureteroscopy during pregnancy using the technique of following the wire ureteroscopically with no need for fluoroscopy.

Patients and Methods

The study included 26 pregnant patients suffering from renal colic not responding to medication between March 2002 and January 2009. Most patients (15) presented during the second trimester, 3 patients during the first trimester and 8 during the last. A 7.5–8 F semi-rigid ureteroscope was introduced without ureteral dilation by advancing the guide-wire (GW) through the ureteroscope into the ureteric orifice and following it stepwise up to the site of obstruction; then the GW was advanced past the obstruction under vision to the kidney. The ureteroscope was removed and re-introduced. Lithotripsy using the Lithoclast was performed and a tipless dormia basked was used for stone extraction. A stent with string was placed for 5–7 days.

Results

Ureteroscopy was successfully performed in all patients without ureteral dilation. Stones (6–9 mm in diameter) were detected in 18 patients. Eleven patients had distal stones while 7 had proximal stones. Fluoroscopy was not required. There were no complications related to the procedure. Requirement for analgesia was reduced due to placement of stents. Stent-related complaints were tolerable. All patients completed full-term pregnancy.

Conclusion

Ureteral obstruction during pregnancy can be safely managed ureteroscopically using the follow-the-wire technique. It obviates the need for ionizing radiation. In experienced hands the technique is safe and reproducible. Application of this technique in non-pregnant patients will reduce exposure to radiation.