Complications and Outcomes of Pregnancy and Cesarean Delivery in Women With Neuropathic Bladder and Lower Urinary Tract Reconstruction

Joshua D. Roth, Jessica T. Casey, Benjamin Whittam, Konrad Szymanski, Martin Kaefer, Richard C. Rink, Frank Schubert, Mark P. Cain, Rosalia Misseri

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: To determine the outcomes of pregnancy and cesarean delivery (CD) in women with neuropathic bladder (NB) and pediatric lower urinary tract reconstruction (LUTR) as these women often have normal fertility and may become pregnant. Methods: We reviewed consecutive patients with NB due to spinal dysraphism who underwent LUTR, became pregnant, and had a CD at our institution from July 2001 to June 2016. We collected data on demographics, hydronephrosis, symptomatic urinary tract infection, continence, and catheterization during pregnancy. CD data included gestational age, abdominal or uterine incisions, and complications. Results: We identified 18 pregnancies in 11 women. Fifteen live newborns were delivered via CD (53.3% term births). Thirteen of 15 patients (86.7%) developed new (10) or worsening (3) hydronephrosis. Six of 13 patients (46.2%) underwent nephrostomy tube placement. Eight of 15 patients (53.3%) developed difficulty catheterizing (66.7% via native urethra, 44.4% via catheterizable channel); 50.0% of patients required an indwelling catheter. Five of 15 patients (33.3%) developed urinary incontinence during pregnancy. Ten of 15 patients (66.7%) had a urinary tract infection (30.0% febrile). A urologist was present for all CDs: 5 were scheduled, 10 occurred emergently. Complications occurred in 40.0% (5 cystotomies, 1 bowel deserosalization, 1 vaginal laceration). All cystotomies occurred during emergent CD. Three patients (20.0%) developed urinary fistulae after emergent CD. Conclusions: Women with NB and LUTR have high rates of complications during pregnancy and CD, despite routine involvement of urologists. Women with prolonged labor, previous CD, or those with a history of noncompliance developed the worst complications. Based on our experience, a urologist should always be present and participate in the CD.

Original languageEnglish (US)
JournalUrology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Neurogenic Urinary Bladder
Pregnancy Complications
Pregnancy Outcome
Urinary Tract
Cystotomy
Hydronephrosis
Urinary Tract Infections
Pregnancy
Urinary Fistula
Term Birth
Spinal Dysraphism
Indwelling Catheters
Lacerations
Urinary Incontinence
Urethra
Catheterization
Gestational Age
Fertility
Fever
Demography

ASJC Scopus subject areas

  • Urology

Cite this

Complications and Outcomes of Pregnancy and Cesarean Delivery in Women With Neuropathic Bladder and Lower Urinary Tract Reconstruction. / Roth, Joshua D.; Casey, Jessica T.; Whittam, Benjamin; Szymanski, Konrad; Kaefer, Martin; Rink, Richard C.; Schubert, Frank; Cain, Mark P.; Misseri, Rosalia.

In: Urology, 01.01.2018.

Research output: Contribution to journalArticle

@article{570ad9c9c54f49e5942e811245078b66,
title = "Complications and Outcomes of Pregnancy and Cesarean Delivery in Women With Neuropathic Bladder and Lower Urinary Tract Reconstruction",
abstract = "Objective: To determine the outcomes of pregnancy and cesarean delivery (CD) in women with neuropathic bladder (NB) and pediatric lower urinary tract reconstruction (LUTR) as these women often have normal fertility and may become pregnant. Methods: We reviewed consecutive patients with NB due to spinal dysraphism who underwent LUTR, became pregnant, and had a CD at our institution from July 2001 to June 2016. We collected data on demographics, hydronephrosis, symptomatic urinary tract infection, continence, and catheterization during pregnancy. CD data included gestational age, abdominal or uterine incisions, and complications. Results: We identified 18 pregnancies in 11 women. Fifteen live newborns were delivered via CD (53.3{\%} term births). Thirteen of 15 patients (86.7{\%}) developed new (10) or worsening (3) hydronephrosis. Six of 13 patients (46.2{\%}) underwent nephrostomy tube placement. Eight of 15 patients (53.3{\%}) developed difficulty catheterizing (66.7{\%} via native urethra, 44.4{\%} via catheterizable channel); 50.0{\%} of patients required an indwelling catheter. Five of 15 patients (33.3{\%}) developed urinary incontinence during pregnancy. Ten of 15 patients (66.7{\%}) had a urinary tract infection (30.0{\%} febrile). A urologist was present for all CDs: 5 were scheduled, 10 occurred emergently. Complications occurred in 40.0{\%} (5 cystotomies, 1 bowel deserosalization, 1 vaginal laceration). All cystotomies occurred during emergent CD. Three patients (20.0{\%}) developed urinary fistulae after emergent CD. Conclusions: Women with NB and LUTR have high rates of complications during pregnancy and CD, despite routine involvement of urologists. Women with prolonged labor, previous CD, or those with a history of noncompliance developed the worst complications. Based on our experience, a urologist should always be present and participate in the CD.",
author = "Roth, {Joshua D.} and Casey, {Jessica T.} and Benjamin Whittam and Konrad Szymanski and Martin Kaefer and Rink, {Richard C.} and Frank Schubert and Cain, {Mark P.} and Rosalia Misseri",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.urology.2017.11.052",
language = "English (US)",
journal = "Urology",
issn = "0090-4295",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Complications and Outcomes of Pregnancy and Cesarean Delivery in Women With Neuropathic Bladder and Lower Urinary Tract Reconstruction

AU - Roth, Joshua D.

AU - Casey, Jessica T.

AU - Whittam, Benjamin

AU - Szymanski, Konrad

AU - Kaefer, Martin

AU - Rink, Richard C.

AU - Schubert, Frank

AU - Cain, Mark P.

AU - Misseri, Rosalia

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: To determine the outcomes of pregnancy and cesarean delivery (CD) in women with neuropathic bladder (NB) and pediatric lower urinary tract reconstruction (LUTR) as these women often have normal fertility and may become pregnant. Methods: We reviewed consecutive patients with NB due to spinal dysraphism who underwent LUTR, became pregnant, and had a CD at our institution from July 2001 to June 2016. We collected data on demographics, hydronephrosis, symptomatic urinary tract infection, continence, and catheterization during pregnancy. CD data included gestational age, abdominal or uterine incisions, and complications. Results: We identified 18 pregnancies in 11 women. Fifteen live newborns were delivered via CD (53.3% term births). Thirteen of 15 patients (86.7%) developed new (10) or worsening (3) hydronephrosis. Six of 13 patients (46.2%) underwent nephrostomy tube placement. Eight of 15 patients (53.3%) developed difficulty catheterizing (66.7% via native urethra, 44.4% via catheterizable channel); 50.0% of patients required an indwelling catheter. Five of 15 patients (33.3%) developed urinary incontinence during pregnancy. Ten of 15 patients (66.7%) had a urinary tract infection (30.0% febrile). A urologist was present for all CDs: 5 were scheduled, 10 occurred emergently. Complications occurred in 40.0% (5 cystotomies, 1 bowel deserosalization, 1 vaginal laceration). All cystotomies occurred during emergent CD. Three patients (20.0%) developed urinary fistulae after emergent CD. Conclusions: Women with NB and LUTR have high rates of complications during pregnancy and CD, despite routine involvement of urologists. Women with prolonged labor, previous CD, or those with a history of noncompliance developed the worst complications. Based on our experience, a urologist should always be present and participate in the CD.

AB - Objective: To determine the outcomes of pregnancy and cesarean delivery (CD) in women with neuropathic bladder (NB) and pediatric lower urinary tract reconstruction (LUTR) as these women often have normal fertility and may become pregnant. Methods: We reviewed consecutive patients with NB due to spinal dysraphism who underwent LUTR, became pregnant, and had a CD at our institution from July 2001 to June 2016. We collected data on demographics, hydronephrosis, symptomatic urinary tract infection, continence, and catheterization during pregnancy. CD data included gestational age, abdominal or uterine incisions, and complications. Results: We identified 18 pregnancies in 11 women. Fifteen live newborns were delivered via CD (53.3% term births). Thirteen of 15 patients (86.7%) developed new (10) or worsening (3) hydronephrosis. Six of 13 patients (46.2%) underwent nephrostomy tube placement. Eight of 15 patients (53.3%) developed difficulty catheterizing (66.7% via native urethra, 44.4% via catheterizable channel); 50.0% of patients required an indwelling catheter. Five of 15 patients (33.3%) developed urinary incontinence during pregnancy. Ten of 15 patients (66.7%) had a urinary tract infection (30.0% febrile). A urologist was present for all CDs: 5 were scheduled, 10 occurred emergently. Complications occurred in 40.0% (5 cystotomies, 1 bowel deserosalization, 1 vaginal laceration). All cystotomies occurred during emergent CD. Three patients (20.0%) developed urinary fistulae after emergent CD. Conclusions: Women with NB and LUTR have high rates of complications during pregnancy and CD, despite routine involvement of urologists. Women with prolonged labor, previous CD, or those with a history of noncompliance developed the worst complications. Based on our experience, a urologist should always be present and participate in the CD.

UR - http://www.scopus.com/inward/record.url?scp=85041561940&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85041561940&partnerID=8YFLogxK

U2 - 10.1016/j.urology.2017.11.052

DO - 10.1016/j.urology.2017.11.052

M3 - Article

C2 - 29305940

AN - SCOPUS:85041561940

JO - Urology

JF - Urology

SN - 0090-4295

ER -