title: Ureteroscopy -- first-line treatment alternative in ureteral calculi during pregnancy?
abstract: BACKGROUND
  Urolithiasis during pregnancy is not common but remains both a diagnostic and treatment challenge. The aim of the study was to assess the ureteroscopy results as definitive treatment option in pregnant women with obstructive ureteral calculi.
  
  
  METHODS
  Between 2006 and 2012, in our clinical department, 54 pregnant women underwent active treatment for ureteral lithiasis and in 38 of these cases ureteroscopy was applied as definitive therapy. The average patients age was 27.2 years (range 20-37 years) and the gestation period varied between 9 to 35 weeks. Flank pain was the common presenting symptom (52 54 cases), 4 women had associated fever, and 14 complained of irritative voiding symptoms.Semirigid ureteroscopy was the first choice alternative for the first 2 trimesters while flexible approach or double J in dwelling were preferred for patients in the last trimester of pregnancy.
  
  
  RESULTS
  Semirigid ureteroscopy allowed stone treatment in 28 32 cases. In 17 patients, calculi fragmentation using Ho:YAG laser or ballistic lithotripsy were performed, while in 11 cases, the stone was removed intact. Minor intraoperative complications were encountered in 5 patients. Postoperatively,urinary tract infection developed in 4 patients, renal colic in 2 and prolonged hematuria in one case, while 4 patients complained of stent-induced bladder irritation. Flexible ureteroscopy was successfully completed in all patients. There were no complications related to this procedure. All pregnancies were carried out to full term.
  
  
  CONCLUSIONS
  Ureteroscopy may be considered a safe and effective first-line definitive therapeutic option in pregnant patients requiring intervention for ureteral stone.
authors.forename: D
authors.initials: D
authors.lastname: Georgescu
authors.forename: R
authors.initials: R
authors.lastname: Mulţescu
authors.forename: B
authors.initials: B
authors.lastname: Geavlete
authors.forename: P
authors.initials: P
authors.lastname: Geavlete
authors.forename: L
authors.initials: L
authors.lastname: Chiuţu
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008096:Lithotripsy; D017602:Lithotripsy, Laser; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D011256:Pregnancy Outcome; D018570:Risk Assessment; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000150:complications / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy; D018666:Ureteroscopy / Q000009:adverse effects