Open Surgery

With the improvements in treatment methods, recourse to surgery to treat a urinary tract calculus remains exceptional. In pregnant women, placing a dou-ble-J stent or a nephrostomy makes it possible to reach the pregnancy's term so that lithotripsy or endoscopic treatment of the stone can be undertaken at that time. Even if surgery in the pregnant patient presents a risk of hemorrhage because of the hypervascularization of the pelvic area, and a nearly 10 % risk of premature delivery (Shnider and Webster 1965), there remain a few exceptional cases where open surgery is the last recourse to removing calculus formation that causes of life-threatening complications. Exceptionally, in pregnant women in a state of urinary sepsis that cannot be controlled by antibiotics and urinary diversion via a ureteral catheter or a nephrostomy, emergency ne-phrectomy is indicated after preparation including va-soactive drugs, platelets, or coagulating factor transfusions if necessary. A three-quarter operating position and a retroperitoneal approach and an experienced surgeon are required to execute quickly the procedure and limit morbidity and mortality.

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