Percutaneous Nephrolithotomy During Early Pregnancy in Urgent Situations: Is It Feasible and Safe?

Mohammad Mehdi Hosseini, Abbas Hassanpour, Ali Eslahi, Leila Malekmakan

Abstract


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Purpose: Urolithiasis during pregnancy poses risks for mother and the fetus with specific challenges in diagnosis and management. We report our experience with urgent percutaneous nephrolithotomy (PCNL) in seven pregnant patients with symptomatic renal stone in early pregnancy.
Materials and methods: Seven pregnant patients with symptomatic renal stones were reviewed. The technique comprised PCNL with complete access under guide of ultrasonography in prone position under general anesthesia
using pneumatic lithoclast for stone fragmentation.
Results: There was no significant residual fragment of stone in the operated kidneys. The patients discharged without complications and delivered their babies healthy.
Conclusion: PCNL should not be considered as the first therapeutic method in the first trimester of pregnancy, unless in urgent situations such as symptomatic renal pelvic stone with moderate to severe hydronephrosis in patients who do not tolerate or are complicated by nephrostomy or internal stent. However, this procedure could be technically demanding and should be done in centers with enough experience and equipment in percutaneous
nephrolithotomy.

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References


Semins MJ, Matlaga BR (2014) Kidney stones during pregnancy. Nat Rev Urol 11:163-8.

Butler EL, Cox SM, Eberts EG, Cunningham FG. Symptomatic nephrolithiasis complicating pregnancy. Obstet Gynecol 2000; 96:753-6.

Srirangam SJ, Hickerton B, Van Cleynenbreugel B. Management of urinary calculi in pregnancy: a review. J Endourol 2008; 22:867-75.

Celik O, Turk H, Cakmak O, Ekin RG, Keskin MZ, Yildiz G, Ilbey YO (2016) Current approach for urinary system stone disease in pregnant women. Arch Ital Urol Androl 87:280-5.

Buchholz NP, Biyabani R, Sulaiman MN, Talati J. Urolithiasis in pregnancy- a clinical challenge. Eur J Obstet Gynecol Reprod Biol 1998; 80:25-9.

Basiri A, Ziaee SA, Nasseh H, Kamranmanesh M, Masoudy P, Heidary F, Kianian H, Abedinzadeh M. Totally ultrasonographyguided percutaneous nephrolithotomy in the flank position. J Endourol 2008; 22:1453-7.

Basiri A, Mohammadi Sichani M, Hosseini SR, Moradi Vadjargah A, Shakhssalim N, Kashi AH, Kamranmanesh M, Nasseh H. X-ray-free percutaneous nephrolithotomy in supine position with ultrasound guidance.

World J Urol 2010; 28:239-44.

McAleer SJ, Loughlin KR. Nephrolithiasis and pregnancy. Curr Opin Urol 2004; 14:123-7.

Zhang S, Liu G, Duo Y, Wang J, Li J, Li C. Application of Ureteroscope in Emergency Treatment with Persistent Renal Colic Patients during Pregnancy. PLoS One 2016; 11:e0146597.

Fregonesi A, Dias FG, Saade RD, Dechaalani V, Reis LO. Challenges on percutaneous nephrolithotomy in pregnancy: Supine position approach through ultrasound guidance. Urol Ann 2013; 5:197-9.

Juan YS, Wu WJ, Chuang SM, Wang CJ, Shen JT, Long CY, Huang CH. Management of symptomatic urolithiasis during pregnancy. Kaohsiung J Med Sci 2007; 23:241-6.

Osman M, Wendt-Nordahl G, Heger K, Michel MS, Alken P, Knoll T. Percutaneous nephrolithotomy with ultrasonography-guided renal access: experience from over 300 cases. BJU Int 2005; 96:875-8.

Kavoussi LR, Albala DM, Basler JW, Apte S, Clayman RV. Percutaneous management of urolithiasis during pregnancy. J Urol 1992; 148:1069-71.

Swanson SK, Heilman RL, Eversman WG. Urinary tract stones in pregnancy. Surg Clin North Am 1995; 75:123-42.

Shah A, Chandak P, Tiptaft R, Glass J, Dasgupta P. Percutaneous nephrolithotomy in early pregnancy. Int J Clin Pract 2004; 58:809-10.

Hosseini MM, Yousefi A, Rastegari M. Pure ultrasonography-guided radiation-free percutaneous nephrolithotomy: report of 357 cases. Springerplus 2015; 4:313.

Alan C, Kocoglu H, Ates F, Ersay AR. Ultrasound-guided X-ray free percutaneous nephrolithotomy for treatment of simple stones in the flank position. Urol Res 2011;39:205-12.

Toth C, Toth G, Varga A, Flasko T, Salah MA. Percutaneous nephrolithotomy in early pregnancy. Int Urol Nephrol 2005; 37:1-3.

Basiri A, Nouralizadeh A, Kashi AH, Radfar MH, Nasiri MR, Zeinali M, Sarhangnejad R, Hosseini-Sharifi SH. X-Ray Free Minimally Invasive Surgery for Urolithiasis in Pregnancy. Urol J 2016; 13:2496-501.

Pedersen H, Finster M. Anaesthetic risk in the pregnant surgical patient. Anaesthesiology 1979; 51: 439–51




DOI: http://dx.doi.org/10.22037/uj.v14i6.3617


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