SAN DIEGO, CA USA (UroToday.com) - The management of kidney stones during pregnancy can be challenging. The goal of this study from the Mayo Clinic was to compare the potential anesthetic risk to the fetus when temporizing stents are placed, compared to definitive management with ureteroscopy.
This study retrospectively reviewed the records of patients diagnosed with urolithiasis, during pregnancy, who underwent surgical intervention from 1997 to 2012.
They identified 26 women with urolithiasis during pregnancy who met the study inclusion criteria, of which 15 (58%) were managed with stents and 11 (42%) underwent ureteroscopic intervention. In the stent group, 6 (40%) required multiple stent exchanges for a mean of 1.47 (range 1-3) anesthetic events and a median anesthetic time of 70 minutes (range 29-208 min). Seven (47%) of the women managed with ureteral stent exchange were induced prior to term due to inability to tolerate the stent. Conversely, the ureteroscopy group had a mean of 1.18 anesthetic events (range 1-2) and 80 minutes (range 37-126 min) of anesthetic exposure. Two patients in the ureterosocpy group (18%) required a second procedure -- either for infection or narrow ureter. No patients from the ureteroscopy group were induced early for pain. Comparing the two groups, there was no significant difference in number of events (p=0.208) or total anesthetic time (p=0.503).
In conclusion, in this study ureteroscopic intervention demonstrated equivalent anesthetic exposure to the fetus compared to temporizing ureteral stents. Furthermore, early induction of labor due to pain was not a concern with ureteroscopy, as it was in several cases of ureteral stenting. The findings of this study support definitive stone management over temporizing stent placement.
Further studies with a larger sample size are necessary to confirm the results of this study, which is limited by the small sample and retrospective nature.
Presented by Kelly McAlvany, DO at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Department of Urology, Mayo Clinic, Rochester, MN USA
Reported for UroToday.com by Samuel Juncal, MD; UC Irvine Medical Center, Orange, CA USA