Rigid ureteroscopy for diagnosis and treatment of ureteral calculi during pregnancy.

OBJECTIVE To evaluate ureteroscopy as a treatment option for women presenting ureteral calculi during pregnancy. MATERIALS AND METHODS Eighteen pregnant patients presenting renal colic and indication of surgical treatment for ureteral calculi were analyzed. Patients were 20 to 34 years old (medium = 28), and the gestation period ranged from 12 to 34 weeks (medium = 18). Lumbar pain was present in 14 patients, and 4 had diffuse abdominal pain. Four patients were febrile in the occasion of the examination. Thirteen patients presented microscopic hematuria, 8 leucocituria, and 4 positive urine culture. The stone was detected by ultrasonography (US) in 12 patients. Magnetic resonance imaging (MRI) was performed in 2 cases, and did not demonstrate calculi. The stone location was: 1 in the superior ureter (pregnancy of 15 weeks), 4 in the medium ureter (pregnancy of 12, 15, 18 and 20 weeks), 12 in the inferior ureter, and 1 was not determined. The surgical indication was difficult pain control, fever, and presence of uterine contractions. RESULTS Double-J insertion, as single treatment, was possible in 4 patients and it was kept in place for up to 2 weeks after delivery. Among the patients submitted to ureteroscopy, the calculi retrieval was always possible, except in 1 case where the calculus was not located by US, MRI or ureteroscopy. In 2 patients, the ultrasonic lithotriptor was used and in 11 the stone was removed intact with a basket. There were no complications due to the procedure and all pregnancies were carried to full term. CONCLUSION Rigid ureteroscopy for extraction of ureteral calculi during pregnancy is efficient and safe.