Clinical presentation and management patterns of ureteral calculi in pregnancy: a 14-year single-institution retrospective study.

Objective: This study aimed to describe the clinical presentation, diagnostic pathway, and management patterns of ultrasound-confirmed ureteral calculi during pregnancy at a single institution. Methods: This study collected, summarized, and analyzed clinical data from 120 pregnant patients diagnosed with ureteral calculi at Fujian Provincial Hospital between March 2010 and March 2024. Primary descriptive outcomes were initial symptom response, documented spontaneous stone passage, subsequent urinary decompression, and residual calculi after pregnancy. Secondary outcomes included technical success of decompression and changes in selected laboratory findings. Maternal-fetal follow-up was not standardized through delivery, and comprehensive obstetric and neonatal outcomes were not systematically available. Results: All patients were initially managed with conservative treatment and achieved symptomatic relief within 24 h. Spontaneous stone expulsion was documented in 90 patients: 51 at ≤1 month, 17 at >1-3 months, and 22 at >3 months. Urinary decompression was required in 57 patients because of fever, aggravated hydronephrosis, or recurrent renal colic. Retrograde D-J stent placement was attempted in all 57 patients and was successful in 47 (82.5%); the remaining 10 patients underwent percutaneous nephrostomy after unsuccessful stent placement. Cystoscopic D-J stent placement attempts were performed using topical urethral anesthesia with 10% lidocaine, whereas percutaneous nephrostomy was performed under local infiltration anesthesia; no miscarriage or preterm labor temporally associated with urinary decompression or the related anesthesia was documented among the 57 patients who underwent decompression. Post-procedural fetal heart rate monitoring was performed in all 57 patients, and no abnormal findings were documented. Thirty cases retained calculi after completion of pregnancy; among them, 8 underwent postpartum ESWL and 22 underwent postpartum ureteroscopic lithotripsy. Among the 120 analyzed patients, neither ESWL nor ureteroscopic holmium laser lithotripsy (URS-HLL) was performed during pregnancy. Among eight febrile patients, mean white blood cell (WBC) count decreased from 14.9 ± 0.19 × 10 Conclusions: This cohort describes a conservative-first management pathway with selective urinary decompression when symptoms or complications persisted. No procedure- or anesthesia-related miscarriage, preterm labor, abnormal post-procedural fetal heart rate finding, or serious urological complication were documented during hospitalization or available urological follow-up among patients who underwent decompression; however, these observations do not establish comprehensive maternal-fetal safety.