MP14-20: Comparison of the effect of active surgical treatment of urolithiasis in pregnant patients compared with serial ureteral stenting on the probability of natural delivery.

Pavel Nizin, Sergey Kotov*, Perov Roman, Moscow, Russian Federation

Introduction: The primary endpoint is to compare the frequency of natural childbirth in the groups undergoing active surgical treatment of urolithiasis and the group of serial ureteral stenting.

Methods: Criteria for inclusion of diagnosed urolithiasis at any stage of pregnancy in patients without abnormalities of the urinary system. Exclusion criteria, independent departure of the stone. The active treatment group underwent endoscopic surgery to get rid of the stone during gestation. The serial stenting group underwent drainage replacement every 4 weeks during the entire period of pregnancy, followed by operations to get rid of the stone after delivery.

Results: Active treatment group n=57 average age 27.2 years (±5.2). The average gestation period was 21.1 weeks (±6.8). Distribution by trimester: I-3.6%, II-73.8%, III–22.8%. The average rate of leukocytosis at admission was 10.9*10^9/l (±4.8*10^9/l).

Serial stenting group n=56 average age 26.5 years (±6.1). The average gestation period was 20.2 weeks (±7.2). Distribution by trimester: I-3 (5.4%), II-43 (76.8%), III–10 (17.8%). The average rate of leukocytosis at admission was 11.6*10^9/l (±5.1*10^9/l).

7 (12%) patients from the first group were diagnosed with acute obstructive pyelonephritis. These patients were fitted with an internal ureteral stent. In 5 patients, there was an independent discharge of the concretion. These patients were excluded from observation.

In the second group, 4 patients were diagnosed with acute obstructive pyelonephritis. An internal ureteral stent was installed in these patients. In 3 patients, against the background of a standing stent, the stone moved away on its own. These patients were excluded from observation.

In the first group, the number of delivery was 35, caesarean section-17. In the second group, delivery-23, CS-30.

The probability of delivery was estimated using ?2 is 6.070. The critical value of ?2 at the significance level p=0.05 is 3.841.

Complications in the first group: grade I-5 (9%), II–7 (13%). Complications in the second group I degree 9 (17%), II – 8 (15%), IIIa - 9 (17%).

Comparison of the development of complications was carried out. The value of the criterion ?2 is 12.724. The critical value of ?2 at the significance level p=0.01 is 11.345.

Conclusions: Active disposal of the stone during pregnancy is safe and reduces the likelihood of delivery by cesarean section and the likelihood of developing stent-associated symptoms.

Source of Funding: The study was not funded.