title: Use of inverted fluoroscope's C-arm during endoscopic treatment of urinary tract obstruction in pregnancy: a practicable solution to cut radiation.
abstract: OBJECTIVE
  To describe the use of pulsed fluoroscopic guidance, to perform endoscopic procedures in pregnant women, by inverting the fluoroscope's c-arm using a lead thyroid collar to shield the fetus from the direct X-ray beam. The use of radiation during treatment of pregnant patients with urolithiasis remains a recurring dilemma.
  
  
  METHODS
  Between May 2006 and December 2008, endoscopic treatment due to ureteral stones was attempted in 8 pregnant women. In all cases, we use an inverted fluoroscope's c-arm during endoscopic treatment associated with 2 lead neck thyroid collars to shield the uterus, protecting the fetus from direct radiation. Indication for treatment was symptomatic ureteral stones unresponsive to medical treatment in 7 and persistent fever in 1.
  
  
  RESULTS
  Mean ureteral stone size was 8.1+/-4.8 mm, located in the left ureter in 5 (62.5%) cases. Three (37.5%) patients had stone located in the upper ureter, 2 (25%) in the middle ureter, and 3 (37.5) in the distal ureter. In 6 cases, ureteral stones were treated using the semi-rigid ureteroscope, whereas in 1 case a flexible ureteroscope was needed. One woman was treated with insertion of a double-J stent due to associated urinary infection. No women has early delivery related to the endoscopic procedure, and all neonates were perfectly normal.
  
  
  CONCLUSIONS
  We present a technique for endoscopic procedures in pregnant women inverting the fluoroscope's c-arm and protecting the fetus from the direct X-ray beam. This practical approach should be specially considered when no portable ultrasound and radiologic assistance in available in the operating room.
authors.affiliation: Department of Urology, University of Sao Paulo (USP), Sao Paulo, Brazil. mcocuzza@uol.com.br
authors.forename: Marcello
authors.initials: M
authors.lastname: Cocuzza
authors.forename: Jose Roberto
authors.initials: JR
authors.lastname: Colombo
authors.forename: Roberto Iglesias
authors.initials: RI
authors.lastname: Lopes
authors.forename: Affonso Celso
authors.initials: AC
authors.lastname: Piovesan
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Borges Mesquita
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000328:Adult; D000775:Anesthesia, Spinal; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation* / Q000379:methods; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011256:Pregnancy Outcome; D011835:Radiation Protection / Q000379:methods*; D018570:Risk Assessment; D012494:Sampling Studies; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal; D014514:Ureteral Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000379:methods*