Objectives: To evaluate the safety and effectiveness of ureteric stenting with a JJ stent in pregnant women, to relieve renal obstruction and intractable flank pain.
Patients and methods: All pregnant patients presenting with intractable flank pain, with or without complications, to a tertiary national teaching hospital in Kurdistan/Iraq, and necessitating ureteric stenting with a JJ stent, were prospectively assessed for this study between March 2008 and March 2010.
Results: In all, 30 pregnant patients presented with intractable flank pain necessitating JJ ureteric stenting during the 25 months. Intractable flank pain (23 patients, 77%) was the most common indication for ureteric stenting, followed by flank pain with clinical sepsis (six, 20%). All pregnant women had hydronephrosis on ultrasonography (US), and 12 (40%) had evidence of coexisting renal stones on US. All ureteric stents were inserted successfully. The mean (range) indwelling time was 47.4 (3-224) days. Radiologically, 14 (47%) and 15 (50%) had complete resolution of the hydronephrosis on follow-up US in late pregnancy and in the early postnatal period, respectively. Two-thirds of patients had a clinical improvement immediately (15, 50%) and soon after (five, 17%) surgery. Stent encrustation (three, 10%), stent migration (three, 10%) and stent irritation (five, 17%) were reported as complications. The post-natal evaluation confirmed that half the patients had urinary calculus disease.
Conclusion: Ureteric stenting during pregnancy can be safe, with no intraoperative imaging and even under local anaesthesia. It provides good symptom relief and has a low complication rate. We therefore advocate it as a first-line treatment in pregnant women with therapy-resistant flank pain.
Keywords: Hydronephrosis; Pregnancy; Stent; US, ultrasonography.