Urological Emergencies in Clinical Practice стр.121

JJ stents have been reported to become obstructed by mechanical impingement of the fetal head (Hellawell et al. 2002) and they may migrate down the ureter and into the bladder and subsequently be voided per urethra as a consequence of the dilatation of the ureter that is normally a feature of pregnancy (Stothers et al. 1992).

Ureteroscopic stone extraction can be performed in pregnancy, but again its use depends on available expertise. Distortion of the distal third of the ureter during the latter stages of pregnancy makes rigid ureteroscopy technically more challenging, as does the presence of a large stone (European Association of Urology 2001). For these reasons the less experienced uretero-scopist may decide that nephrostomy tube drainage or a JJ stent is a better option later on in pregnancy, with subsequent uretero-scopic treatment being used if the stone fails to pass within a few weeks of delivery. In solitary kidneys nephrostomy tube drainage or a JJ stent may also be safer options rather than attempting

8. URETERIC COLIC IN PREGNANCY 159

ureteroscopic stone extraction under the difficult conditions of late pregnancy.

References

American College of Obstetricians and Gynecologists Committee on Obstetric Practice. Guidelines for diagnostic imaging during pregnancy. ACOG Committee Opinion No. 158. Washington DC: ACOG, 1995.

Burke BJ, Washowich TL. Ureteral jets in normal second- and third trimester pregnancy. J Clin Ultrasound 1998;26:423-426.

Coe FL, Parks JH, Lindhermer MD. Nephrolithiasis during pregnancy. N Engl J Med 1978;298:324-326.

Denstedt JD, Razvi H. Management of urinary calculi during pregnancy. J Urol 1992;148:1072-1075.

Doyle LA, Cronan JJ, Breslaw BH, Ridlen MS. New techniques of ultrasound and color Doppler in the prospective evaluation of acute renal obstruction: do they replace the intravenous urogram? Abdom Imaging 1995;20:58-63.

Duncan PG, Pope WD, Cohen MM, Green N. Fetal risk of anesthesia and surgery during pregnancy. Anesthesiology 1986;64:790-794.


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