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Managing pregnancy in patients following complex urological reconstruction

Login to Access Video or Poster Abstract: MP24-13
Sources of Funding: none

Introduction

Many patients following complex urological reconstruction can achieve pregnancy within a normal life. This study aimed to evaluate antenatal and intrapartum management, and outcomes of pregnancy following urinary tract reconstruction. _x000D_

Methods

A retrospective review of data collected prospectively between 2010 and 2015 identified 34 pregnancies in 29 patients (median age 31.2 years, range 17 - 46). Primary abnormality included exstrophy-epispadias (9/29), spinal dysraphism (4/29), sacral agenesis (2/29), Fowler's syndrome (1/29), neuroblastoma (2/29), bladder cancer (1/29), congenital incontinence / small bladder /short urethra (8/29), congenital vesico-ureteric reflux (1/29) and urogenital sinus (1/29). Previous urological reconstruction included augmentation cystoplasty (15), ileal conduit (1), Mitrofanoff channel (15), ureteric reimplantation (4), colposuspension (2), artificial urinary sphincter (2) and antegrade continence enema channel (1). 5 patients had a solitary kidney. _x000D_

Results

There were 35 (1 set of twins) live-births comprising 17 girls and 18 boys. Mean gestation at delivery was 36 weeks (33 - 38) and mean birthweight was 2.78 kg (1.79-3.50). The majority were delivered by elective Caesarean section (94.1%, 32/34) performed jointly by a urologist and obstetrician. Two women sustained bladder injury during surgery with no long-term complications. Another two women developed vesicocutaneous fistulas which resolved spontaneously (6.25%, 2/32). One woman required early (37 weeks) Caesarean section due to worsening hydronephrosis. Pregnancy-related urological complications included UTI requiring hospital admission (11.8%, 4/34) and upper tract obstruction requiring nephrostomy (20.6%, 7/34). Three women had difficulty with the Mitrofanoff, requiring indwelling catheters. No woman had significant deterioration in renal function._x000D_

Conclusions

Pregnancy can be safely managed with preservation of renal function in women with previous urinary tract reconstruction. These women are prone to complications and require shared care and careful monitoring throughout pregnancy to diagnose and manage complications proactively. Patients should be made aware of the impact of pregnancy and the high rate of pregnancy related complications. Although some of these women could potentially achieve a vaginal birth, we favour planned Caesarean section, jointly performed by an obstetrician and urologist, in patients with complex urinary tract reconstruction, in order to avoid the potential maternal and fetal risks of a complex emergency Caesarean section. _x000D_

Funding

none

Authors
Simon Rajendran
Neha Sihra
Patrick O'Brien
Dan Wood
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