Management of Obstructive Ureteric Stones in Pregnancy: A Systematic Review of Clinical Outcomes, Safety Profiles, and Guideline Recommendations

Abstract

Background: Symptomatic urolithiasis during pregnancy accounts for approximately 1.7 admissions per 1,000 deliveries, acting as the most common non-obstetric cause of acute abdominal pain. Obstructive ureteric stones present a complex therapeutic paradox, necessitating a delicate balance between effective maternal intervention and fetal safety Objective: To systematically review the efficacy, safety profiles, and maternal-fetal outcomes of conservative management versus active interventions (Ureteroscopy [URS], Double-J [DJ] stenting, and Percutaneous Nephrostomy [PCN]) for obstructive ureteric stones during pregnancy. Evidence Acquisition: A systematic search of MEDLINE, EMBASE, and the Cochrane Library was conducted up to May 2026. Eligible studies
included clinical trials, cohort studies, and large retrospective series evaluating interventions for symptomatic ureteric stones in pregnant cohorts. Guidelines from the European Association of Urology (EAU) and American Urological Association (AUA) were cross-referenced. Evidence Synthesis: Conservative therapy is successful in 70%–80% of uncomplicated presentations. When conservative management fails, URS with holmium: YAG laser lithotripsy yields excellent definitive stone-free rates (85%–95%) with a low rate of minor complications. Encrustation remains a major limitation for DJ stenting, requiring stent replacement intervals of 4–6 weeks. PCN remains highly effective for immediate decompression in the setting of severe urosepsis or pyonephrosis.
Conclusions: While conservative therapy remains the initial standard of care, URS has emerged as a safe and definitive first-line surgical option in experienced centers. Temporary decompression (DJ stent or PCN) should be reserved for emergency urosepsis or when advanced endourological skills are unavailable.