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Invasive management of proximal ureteral calculi during pregnancy

机译：妊娠期输尿管近端结石的侵入性处理

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Objective To review our experience with invasive management of proximal ureteral calculi during pregnancy when conservative treatment fails. Methods From February 2006 to September 2012, a total of 87 pregnant women received invasive management for proximal ureteral calculi in our center. Invasive management included the following: double-J stent insertion, percutaneous nephrostomy (PCN), and ureteroscopic lithotripsy (URSL). The medical records of these patients were reviewed retrospectively. Results Of the 87 patients, 4 patients received PCN; 19 patients received cystoscopic double-J stent insertion, whereas 2 patients (10.5%) failed in guide wire inserting and switched to ureteroscopic aid; a total of 64 patients received URSL with holmium laser, in which 52 patients (81.2%) had complete fragmentation of calculi; in 9 patients (14.1%), stone fragments retrograde migrated to the renal pelvis; in 3 patients (4.7%), the stone could not be reached because of serious ureteral tortuosity. One patient (1.6%) patient had a threatened abortion, but this problem was resolved immediately using conservative treatment. All patients completed the full term of pregnancy, and no serious obstetric or urologic complications were observed. Conclusion For pregnant patients with proximal ureteral calculi, double-J stent insertion, PCN, and URSL all are effective and safe options when conservative treatment fails. They should be chosen on the basis of different patient's condition. However, patient's postoperative tolerance was poor for double-J stent insertion and PCN; URSL (especially with holmium laser lithotripsy) is more effective and should be considered as the preferred choice.
机译：目的回顾我们保守治疗失败时妊娠期输尿管近端结石侵入性治疗的经验。方法2006年2月至2012年9月，我中心共对87例孕妇进行了输尿管近端结石的侵入性处理。侵入性治疗包括以下内容：双J支架置入，经皮肾造口术（PCN）和输尿管镜碎石术（URSL）。这些患者的病历进行了回顾性审查。结果87例患者中有4例接受了PCN。 19例患者接受了膀胱镜双J支架置入术，而2例（10.5％）的患者因导丝插入失败而改用输尿管镜辅助治疗;总共64例接受激光治疗的URSL患者，其中52例（81.2％）的患者完全结石碎裂; 9例（14.1％）的结石逆行迁移至肾盂;在3名患者（4.7％）中，由于严重的输尿管弯曲而无法触及结石。一名患者（1.6％）有先兆流产，但使用保守治疗可立即解决此问题。所有患者均已完成整个妊娠期，未观察到严重的产科或泌尿科并发症。结论对于输尿管近端结石的孕妇，保守治疗失败时，双J支架置入，PCN和URSL都是有效且安全的选择。应根据不同患者的病情选择它们。但是，患者的双J支架置入和PCN术后耐受性差。 URSL（特别是with激光碎石术）更有效，应被视为首选。

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