E Bey1, Q Manach2, B Peyronnet3, A Even4,5, E Chartier Kastler2, R Walder6, A Ruffion7, M Baron8, A Charlanes9, X Biardeau10, V Quenneville11, B Boillot12, C Duport13, T Tricard14, C Saussine14, X Gamé14, G Capon15, J Kerdraon16, J N Cornu8, C Garabedian17, L Le Normand1, B Perrouin-Verbe18, V Phe2, M A Perrouin-Verbe1. 1. Department of Urology, Hôtel-Dieu Hospital, University of Nantes, Nantes, France. 2. Department of Urology, Pitie-Salpétrière Academic Hospital, Paris 6 University, Paris, France. 3. Department of Urology, University of Rennes, Rennes, France. 4. Department of Neuro-Urology and of Physical Medicine and Rehabilitation, Raymond Poincare Hospital, Garches, France. 5. Versailles Saint-Quentin en Yvelines University, Versailles, France. 6. Gynecology and Obstretrics Department, Croix-Rousse Hospital, University of Lyon, Lyon, France. 7. Department of Urology, Lyon Sud Hospital-Pierre-Bénite, University of Lyon, Lyon, France. 8. Department of Urology, University of Rouen, Rouen, France. 9. Department of Physical Medicine and Rehabilitation, Tenon Academic hospital, Paris 6 University, Paris, France. 10. Department of Urology, University of Lille, Lille, France. 11. Department of Urology, Boulogne-Billancourt Hospital, Paris, France. 12. Department of Urology University of Grenoble, Grenoble, France. 13. Department of Urology, University of Dijon, Dijon, France. 14. Department of Urology, Rangueil Hospital, University of Toulouse, Toulouse, France. 15. Department of Urology, University of Bordeaux, Bordeaux, France. 16. Department of Physical Medicine and Rehabilitation of Kerpape, Ploemeur, France. 17. Department of gynecology and obstetrics, University Hospital of Lille, Lille, France. 18. Department of Physical Medicine and Rehabilitation, Saint-Jacques Hospital, University of Nantes, Nantes, France.
Abstract
PURPOSE: Management of pregnancy and delivery in women with lower urinary tract reconstruction is challenging and the currently available literature is insufficient to guide clinical practice. We report pregnancy and delivery outcomes in this specific population. MATERIALS AND METHODS: We conducted a national multicenter retrospective study (16 centers) including 68 women with 96 deliveries between 1998 and 2019. These women had at least 1 successful pregnancy and delivery after augmentation enterocystoplasty, catheterizable channel creation and/or artificial urinary sphincter implantation. Maternal and fetal complications during pregnancy and delivery were reported, as well as postpartum functional outcomes, according to the delivery mode. The chi-square test and Student's t-test were used to compare categorical and continuous variables, respectively. RESULTS: Overall 32% of reported pregnancies were complicated by febrile urinary tract infections, 13.5% by renal colic and 14.6% required upper urinary tract diversion. In addition, 10% of patients reported transient self-catheterization difficulties and 13.5% reported de novo or increased urinary incontinence. The preterm delivery rate was 35.3%. Elective C-section was performed in 61% of pregnancies. Twenty complications occurred during delivery (20%), including 19 during elective C-section. Urinary continence at 1 year was unchanged for 93.5% of deliveries. Delivery mode (p=0.293) and multiparity (p=0.572) had no impact on urinary continence. CONCLUSIONS: In this population C-section appeared to be associated with a high risk of complications. In the absence of any obstetric or neurological contraindications, vaginal delivery should be proposed as the first line option to the majority of these women.
PURPOSE: Management of pregnancy and delivery in women with lower urinary tract reconstruction is challenging and the currently available literature is insufficient to guide clinical practice. We report pregnancy and delivery outcomes in this specific population. MATERIALS AND METHODS: We conducted a national multicenter retrospective study (16 centers) including 68 women with 96 deliveries between 1998 and 2019. These women had at least 1 successful pregnancy and delivery after augmentation enterocystoplasty, catheterizable channel creation and/or artificial urinary sphincter implantation. Maternal and fetal complications during pregnancy and delivery were reported, as well as postpartum functional outcomes, according to the delivery mode. The chi-square test and Student's t-test were used to compare categorical and continuous variables, respectively. RESULTS: Overall 32% of reported pregnancies were complicated by febrile urinary tract infections, 13.5% by renal colic and 14.6% required upper urinary tract diversion. In addition, 10% of patients reported transient self-catheterization difficulties and 13.5% reported de novo or increased urinary incontinence. The preterm delivery rate was 35.3%. Elective C-section was performed in 61% of pregnancies. Twenty complications occurred during delivery (20%), including 19 during elective C-section. Urinary continence at 1 year was unchanged for 93.5% of deliveries. Delivery mode (p=0.293) and multiparity (p=0.572) had no impact on urinary continence. CONCLUSIONS: In this population C-section appeared to be associated with a high risk of complications. In the absence of any obstetric or neurological contraindications, vaginal delivery should be proposed as the first line option to the majority of these women.