title: Invasive management of proximal ureteral calculi during pregnancy.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors: Institute of Clinical Anatomy, Southern Medical University, Guangzhou, Guangdong, China; Department of Urology, The Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, Guangdong, China.
authors: Zhifeng
authors: Z
authors: Wang
authors: Department of Urology, The Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, Guangdong, China.
authors: Le
authors: L
authors: Xu
authors: Department of Urology, The First Affiliated Hospital of JINAN University, Guangzhou, Guangdong, China. Electronic address: 541162750@qq.com.
authors: Zexuan
authors: Z
authors: Su
authors: Department of Urology, The Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, Guangdong, China.
authors: Cong
authors: C
authors: Yao
authors: Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors: Zhi
authors: Z
authors: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006695:Holmium; D006801:Humans; D008096:Lithotripsy; D009403:Nephrostomy, Percutaneous; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000150:complications* / Q000601:surgery / Q000628:therapy*; D018666:Ureteroscopy; D055815:Young Adult
chemical_list: D006695:Holmium