DR. K. LALITHAM.D., M.Ch.(UROLOGY)

UROLOGIST & GYNECOLOGIST

MBBS – KMC, WARANGAL-1988MD(OBG)-PGIMER(CHANDIGARH)-1991MCh(UROLOGY)-OMC(HYD)-1997AREA OF INTEREST-FEMALE UROLOGY

UROGYNECOLOGY

MANAGEMENT OF URETERIC STONES DURING PREGNANCY

DR.LALITHAUROLOGIST &UROGYNECOLOGISTYASHODA HOSPITAL,SOMAJIGUDA

INTRODUCTION

• RENAL COLIC IS THE MOST COMMON NON-OBSTETRIC INDICATION FOR HOSPITALIZATION

• UROLITHIASIS INCREASES THE RISK OF PRETERM LABOUR FROM 3% TO 7%

• UROLITHIASIS AFFECTS 1 IN 200 TO 1IN 1500

INTRODUCTION

• CONSERVATIVE TREATMENT IS THE MAINSTAY

• 15% REQUIRE UROLOGICAL INTERVENTION

• DOUBLE J STENTING WAS THE STANDARD FORM OF TREATMENT

AIM

• TO STUDY THE SAFETY AND FEASIBILITY OF URETEROSCOPIC LITHOTRIPSY DURING PREGNANCY

• TO DISCUSS THE DIAGNOSTIC & THERAPEUTIC CHALLENGES

MATERIAL & METHODS

A RETROSPECTIVE STUDY OF 220 PREGNANT WOMEN WITH UROLITHIASIS TREATED BY US BETWEEN FEB 2002 TO FEB 2012

40 WOMEN REQUIRED ACTIVE ENDOUROLOGICAL INTERVENTION.

DIAGNOSTIC TOOLS

• ULTRASOUND KUB - DD PHYSIOLOGICAL HYDRONEPHROSIS

• MR UROGRAPHY

• IVP / CT ARE CONTRAINDICATED

INDICATIONS FOR INTERVENTION

• RENAL COLIC

• INCREASING HYDRONEPHROSIS

• UROSEPSIS

• OLIGURIA / ANURIA

Lower ureteric stone with hydroureter

RESULTS -TYPE OF INTERVENTION

• URETEROSCOPIC STONE REMOVAL FOR DISTAL URETERIC STONES - 18

• DOUBLE J STENTING FOR WOMEN WITH PROXIMAL URETERIC STONES - 22

RESULTS

• 18 - DISTAL URETERIC STONES• 3 STONES > 1 CM

• 1 CASE OF TWIN PREGNANCY

• 1 - BICORNUATE UTERUS

RESULTS

COMPLICATIONSUROLOGICAL - UROSEPSIS - NIL URETERIC PERFORATION – NIL

OBSTETRIC - PRETERM LABOUR - 1

DISCUSSION

• URETERIC STONE DURING PREGNANCY MAY SOMETIMES REQUIRE UROLOGICAL INTERVENTION

• DIAGNOSTIC DILEMMA DUE TO PHYSIOLOGICAL HYDRONEPHROSIS DUE TO INABILITY TO USE X-RAYS

DISCUSSION

• THERAPEUTIC CHALLENGES

• ESWL CONTRAINDICATED• INTRA-OP C-ARM CANNOT BE USED• DIFFICULT TO ACCESS PROXIMAL URETER• RISK OF ANAESTHESIA TO THE FETUS

DISCUSSION

• DOUBLE J STENTING - STANDARD APPROACH

• RECENT ADVANCES IN ENDOUROLOGY MADE URETEROSCOPIC LITHOTRIPSY A SAFER ALTERNATIVE

ADVANTAGES

• SECOND PROCEDURE AVOIDED

• STENT RELATED COMPLICATIONS AVOIDED• LUTS• HEMATURIA• ENCRUSTATIONS

CONCLUSION

• URETEROSCOPIC LITHOTRIPSY DURING PREGNANCY IS FEASIBLE AND SAFE IN A SELECT GROUP OF PATIENTS IN A WELL EQUIPPED ENDOUROLOGY UNIT

• A TEAM OF EXPERTS IN UROLOGY, OBSTETRICS,RADIOLOGY & ANAESTHESIOLOGY IS ESSENTIAL FOR OPTIMAL OUTCOME.