Ureteroscopy during pregnancy with follow-the-wire technique
Purpose: To present our experience with ureteroscopy during pregnancy using the technique of following the wire ureteroscopically with no need for fluoroscopy. Patients and Methods: The study included 26 pregnant patients suffering from renal colic not responding to medication between March 2002 and January 2009. Most patients (15) presented during the second trimester, 3 patients during the first trimester and 8 during the last. A 7.5-8 F semi-rigid ureteroscope was introduced without ureteral dilation by advancing the guide-wire (GW) through the ureteroscope into the ureteric orifice and following it stepwise up to the site of obstruction; then the GW was advanced past the obstruction under vision to the kidney. The ureteroscope was removed and re-introduced. Lithotripsy using the Lithoclast was performed and a tipless dormia basked was used for stone extraction. A stent with string was placed for 5-7 days. Results: Ureteroscopy was successfully performed in all patients without ureteral dilation. Stones (6-9 mm in diameter) were detected in 18 patients. Eleven patients had distal stones while 7 had proximal stones. Fluoroscopy was not required. There were no complications related to the procedure. Requirement for analgesia was reduced due to placement of stents. Stent-related complaints were tolerable. All patients completed full-term pregnancy. Conclusion: Ureteral obstruction during pregnancy can be safely managed ureteroscopically using the follow-the-wire technique. It obviates the need for ionizing radiation. In experienced hands the technique is safe and reproducible. Application of this technique in non-pregnant patients will reduce exposure to radiation.
Key Words: Ureteroscopy, pregnancy, stones