Authors: Fardus Alshangiti , Ahmad M.Alridahie , Abdullah M. Alqahtani , Lama F. Alqahtani , Abdullah Alsaeed , Mohammed Khalid Murtada , Elaf Abdullah Bin Rabah

Abstract

Background: Urolithiasis in pregnancy poses clinical challenges due to maternal physiological changes and the limiting of treatment options. Ureteroscopy is the preferred minimally invasive intervention, but optimal anesthesia selection remains debated. General, spinal, and local anesthesia each carry distinct benefits and risks regarding maternal and fetal safety. This systematic review and meta-analysis aim to compare these techniques across maternal, fetal, and operative outcomes to guide clinical decision-making in this population.

Methods:  A systematic literature search was conducted, reporting items for Systematic Reviews and Meta-Analyses 26 records across PubMed, Web of Science, and Google Scholar from 2014 till 2025. Inclusion criteria were the studies involving pregnant patients undergoing ureteroscopy with focusing on anaesthesia modality and maternal, foetal, and procedural outcomes. Methodological quality was assessed using the Newcastle–Ottawa Scale.

Results: Five observational studies encompassing 311 ureteroscopy (URS) procedures across 387 pregnant women met the inclusion criteria. Pooled data demonstrated a low incidence of significant maternal morbidity: sepsis, ICU hospitalization, and ureteral perforation each occurred at rates below 1%. The overall maternal complication rate was 11.0% (95% CI: 0.6%–32.1%), with urinary tract infection (UTI) representing the most frequent adverse event. Fetal outcomes were highly reassuring, with a live birth rate of 99.2% (95% CI: 96.7%–100%), a miscarriage rate of 0.4%, and a procedural success rate of 98.2% (95% CI: 82.7%–100%). The overall quality of evidence was acceptable for observational surgical literature in pregnancy, with most studies reporting clinically relevant maternal, fetal, and procedural outcome data.

Conclusion: URS in pregnancy is generally safe and effective, but the field needs better pre-op imaging and standardized research to fill critical knowledge gaps.

Keywords: Pregnancy, ureteroscopy, urolithiasis, URS.