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CUAJ %u2022 FEBRUARY 2025 %u2022 VOLUME 19, ISSUE 2 11Anesthesia for renal colic and preterm birthexpulsive therapy options are more limited compared to the non-pregnant patient. The use of tamsulosin (Food and Drug Administration category B) is considered off-label, non-steroidal anti-inflammatories are contraindicated during pregnancy, codeine is contraindicated in the first trimester due to teratogenic effects, and while narcotics are generally considered safe, they can be associated with neonatal abstinence syndrome.8The overall spontaneous stone passage rate in pregnant women has been reported to be 64.3%u201384%, but for stones in certain locations %u2014for example, the ureteropelvic junction %u2014 it may as low as 27.3%.9Conservative management is not always successful, with an estimated 5%u201326% of pregnant women with suspected stones ultimately requiring procedural intervention, including percutaneous nephrostomy tube (PCN), ureteral stent, or primary ureteroscopy (URS), with the potential for multiple subsequent procedures.4,10 These procedures all have accompanying anesthetic risks, whether local, sedation, regional, or general anesthesia is used. For procedural management of urolithiasis during pregnancy, anesthesia choice may vary based on available resources and patient or physician preferences, as there are no specific recommendations.In the present study, our objective was to evaluate whether preterm birth (<37 weeks), was associated with anesthesia type, anesthesia timing by trimester, or procedure type.METHODSPatient populationAfter obtaining internal review board approval, we completed a retrospective review of pregnant patients who required procedural management with ureteral stent, PCN, or primary URS for clinically suspected symptomatic urolithiasis from January 1, 2009, to December 31, 2021, at our large, multicenter, academic, tertiary care center. Inclusion criteriaPatients were included if they were pregnant when they presented with symptoms of renal colic (e.g., flank pain, nausea, or vomiting) and required procedural management during the pregnancy. Renal colic was suspected if imaging showed hydronephrosis and at least one of the following additional criteria; microscopic or gross hematuria, stone crystals on urinalysis, pyuria, absent ureteral jets, resistive indices consistent with obstruction, or stone(s) clearly noted on imaging. Patients were excluded from analysis if they were under 18 years of age at the time of the procedure, renal colic was managed non-operatively, there were no clinical signs of obstructing nephrolithiasis (see criteria above), or there was incomplete data in the electronic medical record. Stent removal under anesthesia was not included as an anesthetic event, as this only occurred in four patients. Two births with underlying fetal anomalies (one due to genetic abnormalities, and one due to the umbilical cord being wrapped around the baby%u2019s foot) resulting in intrauterine fetal demise were also excluded. Data collectionIndividual medical records were abstracted for demographic information, previous medical and obstetric history, presenting symptomatology, and urologic interventions. The indications for procedural management were the same as is typical for non-pregnant stone patients, including intractable symptoms, acute kidney injury, or concern for infection. The type of procedure was urologist-dependent after discussion with the patient. The type of anesthesia was agreed upon by the entire team, including the anesthesiologist, obstetrician (or maternal-fetal medicine specialist), and urologist after discussion with the patient. The primary outcome was preterm birth, with a secondary interest of gestational age at birth. In addition, we aimed to understand the range of anesthesia used by trimester for each procedure type. KEY MESSAGES%u2588 Anesthesia type for procedural management of renal colic was not associated with preterm birth.%u2588 Trimester of anesthetic exposure was not associated with preterm birth. %u2588 Percutaneous nephrostomy tube was associated with the use of less invasive analgesia or anesthesia.%u2588 Ureteroscopy and ureteral stent were associated with lower rates of preterm birth and longer gestational age at delivery compared to percutaneous nephrostomy tube.