妊娠中の経皮的腎結石砕石術：包括的レビューと技術的洞察

Urinary stones in pregnancy are usually managed conservatively or with temporary drainage, but in some cases, intervention is needed. Percutaneous nephrolithotomy (PCNL) is generally avoided due to its invasiveness and the requirement for fluoroscopy. This study aimed to review the literature on the use of PCNL in pregnancy, focusing on its safety, efficacy, feasibility, and technical aspects.

A narrative literature review was conducted using PubMed, Embase, and Scopus databases, covering the period from January 2000 to March 2024. The search terms included "percutaneous nephrolithotomy", "PCNL", "pregnancy", and relevant variations thereof. The initial search retrieved 27 articles, of which only six studies involving 14 patients met the inclusion criteria.

The reviewed studies included patients aged 23-34 years who underwent PCNL between 8 weeks and 28 weeks of gestation. Preoperative evaluations were exclusively based on ultrasound imaging, with stone sizes ranging from 8 mm to 48 mm. Indications for PCNL were persistent pain despite urinary diversion or reluctance to undergo stent replacement. Fluoroscopy was avoided in 13 patients. No maternal or fetal complications were reported.

PCNL appears to be a safe and feasible treatment option for selected cases of urinary stone disease during pregnancy. It should be performed in experienced centers, with proper patient counseling and a multidisciplinary approach to ensure the best outcomes.