title: Ureteroscopy and holmium laser lithotripsy: is this procedure safe in pregnant women with ureteral stones at different locations?
abstract: OBJECTIVE
  The aim of this study was to assess the safety and effectiveness of ureteroscopy and Holmium: Yttrium-Aluminum-Garnet lithotripsy for the treatment of ureteral stones with different localizations in symptomatic pregnant women.
  
  
  METHODS
  A retrospective analysis was performed on 19 pregnant patients referred to our center between January 2005 and December 2012 with symptomatic hydronephrosis requiring surgical intervention. 7.5 F and 9.5 F semirigid ureterorenoscopy with Holmium laser lithotripsy was used for treatment in all patients. Complications were stratified according to modified Clavien criteria.
  
  
  RESULTS
  The mean age of patients was 25.4 (18-41) years, and the mean gestation duration was 24.8 (7-33) weeks. Six cases (31.5%) had a history of stone. Solitary kidney secondary to previous nephrectomy was observed in 2 patients and 1 patient had a hypoplastic kidney. Abdominal ultrasonography was used as the main diagnostic tool. Mean stone size was 9.2 mm (6-13). The location of the stones was the lower, middle, and upper ureter in 8 (42.1%), 5 (26.3%) and 6 (31.5%) cases, respectively. All stones were fragmented with Holmium laser lithotripsy. Of the 19 patients, 11 (57.8%) required double J stent insertion peroperatively. Intraoperative urological and obstetric complications were not observed. Postoperatively two complications were noted. According to Clavien criteria a complication was level 1, and the other was level 2.
  
  
  CONCLUSIONS
  For treatment of pregnant women with symptomatic ureteral stones in every location, Holmium laser lithotripsy with a semirigid ureteroscopy can be used as judicious treatment. This approach is effective and safe with an acceptable complication rate.
authors.affiliation: Department of Urology, Medical Faculty, Ataturk University. s.adanur61@hotmail.com.
authors.forename: Senol
authors.initials: S
authors.lastname: Adanur
authors.forename: Tevfik
authors.initials: T
authors.lastname: Ziypak
authors.forename: Fevzi
authors.initials: F
authors.lastname: Bedir
authors.forename: Turgut
authors.initials: T
authors.lastname: Yapanoglu
authors.forename: Hasan Riza
authors.initials: HR
authors.lastname: Aydın
authors.forename: Mehmet
authors.initials: M
authors.lastname: Yılmaz
authors.forename: Mehmet
authors.initials: M
authors.lastname: Aksoy
authors.forename: Isa
authors.initials: I
authors.lastname: Ozbey
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006695:Holmium / Q000627:therapeutic use; D006801:Humans; D017602:Lithotripsy, Laser / Q000009:adverse effects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D014514:Ureteral Calculi / Q000473:pathology / Q000628:therapy*; D018666:Ureteroscopy; D055815:Young Adult
chemical_list: D006695:Holmium