Ureteroscopy and holmium laser lithotripsy in pregnancy: stents must be used postoperatively

PURPOSE: To present our experience with ureteroscopy and holmium laser lithotripsy in pregnant patients and discuss the need for stents postoperatively. PATIENTS AND METHODS: A retrospective analysis was performed on seven consecutive pregnant patients presenting with renal colic necessitating intervention between 1997 and 2003. One patient presented during the first, five in the second, and one in the third trimester. Abdominal ultrasonography was the primary diagnostic test. If the stone could not be seen with a rigid ureteroscope, flexible ureteroscopy (f-URS) was performed. Stones were fragmented with a holmium laser, and large fragments were taken out. Ureteral stents were placed routinely in all but the first two patients. RESULTS: The ureteral stones could be seen with ultrasonography in three patients. In four patients, holmium lasertripsy could be done by the rigid ureteroscope. In the remaining patients, f-URS was performed, and two upper-system stones were fragmented. Six patients were rendered stone free. In one patient, both collectingsystem dilation and right perirenal liquid accumulation were present by ultrasonography, but no stones could be detected. Ureteral-stent insertion reduced postoperative pain and analgesic use in the whole group. CONCLUSIONS: When conservative therapy fails in the pregnant patient with a ureteral stone, ureteroscopy and holmium lasertripsy should be considered. Routine insertion of ureteral stents with pull-out strings for at least 72 hours will reduce the pain and analgesic use postoperatively.