Multicenter Review of Obstetric Management and Complications of Ureteroscopy During Pregnancy

Introduction and Objectives: Managing nephrolithiasis during pregnancy requires collaboration between obstetricians and urologists. When surgical intervention is needed, ureteroscopy (URS) is a safe and effective; however, limited data exist on obstetric (OB) management and complications of URS during pregnancy. This multicenter study aimed to clarify OB practice patterns and complications of URS in pregnant patients. Methods: A multicenter retrospective review of pregnant patients who underwent URS with fellowship-trained endourologists at seven institutions from 2015 to 2024 was performed. We recorded patient demographics, indications for URS, preoperative workup, intraoperative details, perioperative OB involvement, fetal monitoring (FM) practices, and postoperative OB complications within 30 days. Results: We identified 72 cases of URS during pregnancy. Mean maternal age was 30 years, and mean gestational age was 23.5 weeks. Preoperative imaging was performed in all cases, with ultrasound used in 70/72 (97%). No intraoperative complications were noted. OB involvement and FM varied among institutions—one site required perioperative OB presence with FM, five sites performed FM case-by-case, and one site required pre- and postoperative nonstress tests (NST). FM was done in 11/72 cases, while intraoperative FM was performed in 16/72 cases. OB was present in 13/72 cases. OB complications occurred in eight cases. There were no cases of preterm labor in the immediate perioperative; however, three cases had postoperative admissions with spontaneously resolving contractions and abnormal NST. The two cases of preterm labor requiring C-section at 27 weeks were linked to OB comorbidities. Conclusions: URS is safe in pregnancy in the care of urologists who are experienced in stone disease. OB management and FM during URS are heterogeneous across institutions. In this multicenter series, there were no cases of preterm labor. Cases of early contractions and abnormal NST resolved spontaneously. Standardization of OB practice patterns during URS could be beneficial and incorporated in further guideline development.