PEDIATRIC UROLOGY

The urological care and outcome of pregnancy after urinary tract reconstruction
Hensle TW, Bingham JB, Reiley EA, Cleary-Goldman JE, Malone FD, Robinson JN
Division of Paediatric Urology, Children’s Hospital of New York Presbyterian, and Division of Maternal-Fetal Medicine, Sloane Hospital for Women, Columbia University, College of Physicians and Surgeons, and Division of Paediatric Urology, Hackensack University Medical Center, NY, USA
BJU Int. 2004; 93: 588-590

• Objective: To assess the obstetric and urological outcomes during and after pregnancy following urinary tract reconstruction, as pregnancies after such surgery can have a significant effect on the function of the reconstructed urinary tract, and the reconstruction can significantly affect the delivery of the fetus.
• Patients and Methods: We retrospectively reviewed the obstetric and urological history of 11 patients (12 pregnancies; 10 singletons and one twin) with previous urinary reconstruction, delivered between 1989 and 2003. Antepartum and postpartum urological function and obstetric outcomes were investigated.
• Results: All the patients had some difficulty with clean intermittent catheterization (CIC) during pregnancy, and four needed continuous indwelling catheters. During pregnancy 10 women had several bladder infections and all received antibiotic suppression. There were eight Caesarean sections, two vaginal deliveries and one combined delivery. Six Caesareans were elective and three were emergent. The use of CIC returned to normal in all patients after delivery.
• Conclusions: Women with a urinary reconstruction can have successful pregnancies. The complexity of the surgery and the concern for possible emergency Caesarean section resulted in most patients having an elective Caesarean delivery before term. Antibiotic prophylaxis is recommended and patients may require indwelling dwelling catheters while pregnant but normal CIC can be resumed after delivery.
  
  
• Editorial Comment
  Nearly all parents of girls with major urological anomalies are interested in the reproductive possibilities for their children and whether the reconstructive procedures used to correct them will interfere with sexual function, fertility and pregnancy. The authors report a fascinating series of patients who became pregnant after extensive urinary tract reconstruction, including continent urinary diversion in most and augmentation cystoplasty in others. Many had continent urinary stomas and all were on intermittent catheterization. Surprisingly, problems were encountered with intermittent catheterization in all patients during the pregnancy. In four cases this resulted in chronic indwelling catheter drainage during the pregnancy. Most all the patients had significant urinary tract infections during the pregnancy and most required a Caesarean section. Indeed, a number of the patients underwent an elective Caesarean section prior to term due to the complexity of the procedure in the face of the complex reconstruction with atypical blood supply to the urinary reservoir and stoma. All patients returned to baseline post-delivery including being able to resume normal intermittent catheterization. This report will be very useful in counseling parents and patients prior to major urological reconstructive surgery.

Dr. Barry A. Kogan
Chief and Professor of Urology and Pediatrics
Albany Medical College
Albany, New York, USA