title: Double-J ureteric stenting in pregnancy: A single-centre experience from Iraq.
abstract: OBJECTIVE
  To evaluate the safety and effectiveness of ureteric stenting with a JJ stent in pregnant women, to relieve renal obstruction and intractable flank pain.
  
  
  METHODS
  All pregnant patients presenting with intractable flank pain, with or without complications, to a tertiary national teaching hospital in Kurdistan/Iraq, and necessitating ureteric stenting with a JJ stent, were prospectively assessed for this study between March 2008 and March 2010.
  
  
  RESULTS
  In all, 30 pregnant patients presented with intractable flank pain necessitating JJ ureteric stenting during the 25 months. Intractable flank pain (23 patients, 77%) was the most common indication for ureteric stenting, followed by flank pain with clinical sepsis (six, 20%). All pregnant women had hydronephrosis on ultrasonography (US), and 12 (40%) had evidence of coexisting renal stones on US. All ureteric stents were inserted successfully. The mean (range) indwelling time was 47.4 (3-224) days. Radiologically, 14 (47%) and 15 (50%) had complete resolution of the hydronephrosis on follow-up US in late pregnancy and in the early postnatal period, respectively. Two-thirds of patients had a clinical improvement immediately (15, 50%) and soon after (five, 17%) surgery. Stent encrustation (three, 10%), stent migration (three, 10%) and stent irritation (five, 17%) were reported as complications. The post-natal evaluation confirmed that half the patients had urinary calculus disease.
  
  
  CONCLUSIONS
  Ureteric stenting during pregnancy can be safe, with no intraoperative imaging and even under local anaesthesia. It provides good symptom relief and has a low complication rate. We therefore advocate it as a first-line treatment in pregnant women with therapy-resistant flank pain.
authors.affiliation: Department of Urology, Queen Elizabeth Hospital, Hong Kong, China.
authors.forename: Ho-Yin
authors.initials: HY
authors.lastname: Ngai
authors.affiliation: Consultant Urologist, Shorsh Hospital, Sulaimani, Iraq.
authors.forename: Hawre Qadir
authors.initials: HQ
authors.lastname: Salih
authors.affiliation: Department of Urology, Medical City Hospital, Baghdad, Iraq.
authors.forename: Ayad
authors.initials: A
authors.lastname: Albeer
authors.affiliation: Department of Surgery, University of Sulaimani, Sulaimani, Iraq.
authors.forename: Ismaeel
authors.initials: I
authors.lastname: Aghaways
authors.affiliation: Department of Urology, Bartshealth NHS Trust, The Royal London Hospital, London, UK.
authors.forename: Noor
authors.initials: N
authors.lastname: Buchholz
keywords: Hydronephrosis; Pregnancy; Stent; US, ultrasonography