title: Ureteroscopy and holmium laser lithotripsy in pregnancy: stents must be used postoperatively.
abstract: OBJECTIVE
  To present our experience with ureteroscopy and holmium laser lithotripsy in pregnant patients and discuss the need for stents postoperatively.
  
  
  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.
authors.affiliation: Department of Urology, Group Florence Nightingale Hospitals, School of Medicine, Istanbul, Turkey. halukakpinar@lycos.com
authors.forename: Haluk
authors.initials: H
authors.lastname: Akpinar
authors.forename: Ilter
authors.initials: I
authors.lastname: Tüfek
authors.forename: Bülent
authors.initials: B
authors.lastname: Alici
authors.forename: Ali Riza
authors.initials: AR
authors.lastname: Kural
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017602:Lithotripsy, Laser / Q000379:methods*; D011247:Pregnancy; D011248:Pregnancy Complications; D019919:Prosthesis Implantation / Q000295:instrumentation*; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014513:Ureter / Q000000981:diagnostic imaging / Q000601:surgery*; D014514:Ureteral Calculi / Q000000981:diagnostic imaging / Q000628:therapy*; D018666:Ureteroscopy / Q000379:methods*