The Safety of Ureteroscopy During Pregnancy: A Systematic Review and Meta-Analysis

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Abstract
We performed a literature review and analysis to compare the safety of ureteroscopic stone removal during pregnancy with findings from a set of contemporary studies of that procedure in nonpregnant patients. A systematic review of MEDLINE(R) and EMBASE(R) was done to identify all reports of ureteroscopic stone removal in pregnant women. Complications were stratified according to modified Clavien criteria. We then reviewed a contemporary, multi-national meta-analysis of ureteroscopic stone removal (American Urological Association/European Association of Urology 2007 Guideline for the Management of Ureteral Calculi) to define the complication rate in a series of nonpregnant patients. Complication rates in the 2 reviews were compared using Fisher's exact test. A total of 14 reports of ureteroscopic stone removal in pregnant women were identified, representing 108 patients. Nine complications were noted. By Clavien criteria 2 complications were level 1, 6 were level 2 and 1 was level 3. When compared to the multinational meta-analysis of ureteroscopy in nonpregnant women, there was no significant difference in the ureteral injury and urinary tract infection complication rates (p = 0.191 and 0.597, respectively). Our analysis shows that the safety of ureteroscopic stone removal in pregnant patients is not significantly different from the safety of that procedure in nonpregnant patients and in each cohort the complication rate is low. Therefore, ureteroscopic stone removal may reasonably be considered appropriate first line therapy in pregnant patients with stone disease.