Skip to main content
×
×
Home
  • Print publication year: 2008
  • Online publication date: May 2010

Chapter 19 - Urologic Complications

from Part III - SURGICAL PROCEDURES
Summary
This chapter reviews conditions occurring in the urinary tract during pregnancy that place the mother, and often the fetus, at risk. Conditions discussed in the chapter that might require surgery during pregnancy include urolithiasis, urinary tract obstruction, accidental and iatrogenic lower urinary tract injury, urethral diverticula, genitourinary fistulas, complications of previous urologic surgery, and urinary tract carcinoma. The normal homeostatic changes involving the urinary tract are frequently responsible for the gravid woman's urinary complaints. The treatment of choice for distal ureteral calculi in pregnant patients who require intervention is cystoscopic examination, followed by either passage of a ureteral stent to relieve obstruction, or ureteroscopy with calculus manipulation. During labor and delivery, the bladder is vulnerable to trauma and injury. Mucosal congestion, submucosal hemorrhage, and capillary oozing around the trigone have been observed cystoscopically after delivery.
Recommend this book

Email your librarian or administrator to recommend adding this book to your organisation's collection.

Operative Obstetrics
  • Online ISBN: 9780511580987
  • Book DOI: https://doi.org/10.1017/CBO9780511580987
Please enter your name
Please enter a valid email address
Who would you like to send this to *
×
REFERENCES
Chaliha, C, Stanton, SL: Urological problems in pregnancy. BJU International 2002;89:469–476.
Goldberg RP, Lobel RW, Sand PK: The urinary tract in pregnancy. In: Bent, AE, Ostergard, DR, Cundiff, GW, Swift, SE (eds): Urogynecology and Pelvic Floor Dysfunction. Baltimore: Williams & Wilkins, 2003: pp. 225–243.
Newton ER: The urinary tract in pregnancy. In: Walters, MD, Karram, MM (eds): Urogynecology and Reconstructive Pelvic Surgery. St. Louis: CV Mosby, 1999: pp. 399–417.
Mattingly RF, Borkowf HI: Surgical disease in pregnancy. In: Barber, HRK, Graber, EA (eds): Lower Urinary Tract Injuries in Pregnancy. Philadelphia: WB Saunders, 1974: pp. 440–464.
Meyers, DR, Lee, RV, Munschauer, RW: Dilatation and nontraumatic rupture of the urinary tract during pregnancy: A review. Obstet Gynecol 1985;66: 809–815.
Voigt, R, Voigt, P, Klinger, G, Schneider, HJ: Urographic investigations on the effect of high-dose progestagen therapy. Rofo 1976;125:458–460.
Marchant, DJ: Effects of pregnancy and progestational agents on the urinary tract. Am J Obstet Gynecol 1972;112: 487–501.
Freed SZ: The bladder and urethra in pregnancy. In: Freed, SZ, Herzig, N (eds): Urology in Pregnancy. Baltimore: Williams & Wilkins, 1982: pp. 22–31.
Iosif, S, Ingermarsson, I, Ulmsten, U: Urodynamic studies in normal pregnancy and the puerperium. Am J Obstet Gynecol 1980;137: 696–700.
Goldberg RP, Sand PK: Obstetric issues and the female pelvis. In: Vasavada, SP, Appell, RA, Sand, PK, Raz, S (eds): Female Urology, Urogynecology, and Voiding Dysfunction. New York: Marcel Dekker, 2005: pp. 95–116.
Baessler K, Schuessler B: Pregnancy, childbirth, and pelvic floor damage. In: Bourcier, AP, McGuire, EJ, Abrams, P (eds): Pelvic Floor Disorders. Phila- delphia: Elsevier Saunders, 2004: pp. 33–42.
Toozs-Hobson P, Cutner A: Pregnancy and childbirth. In: Cardozo, L, Staskin, D (eds): Textbook of Female Urology and Urogynaecology. London: Isis Medical Media Ltd, 2001: pp. 977–992.
Robertson EG: Alterations in renal function during pregnancy. In: Buchsbaum, HJ, Schmidt, JD (eds): Gynecologic and Obstetric Urology. Philadelphia: WB Saunders, 1993: pp. 607–620.
Newton ER: The acute abdomen in pregnancy. In: Sciarra, JJ, Speroff, L, Simpson, JL (eds): Gynecology and Obstetrics. Philadelphia: JB Lippincott, 1991; pp. 1–17.
Klein, EA: Urologic problems of pregnancy. Obstet Gynecol Survey 1984;39:605–615.
Francis, WJ: Disturbances of bladder function in relation to pregnancy. J Obstet Gynaecol Br Emp 1960;67:353–366.
Parboosingh, J, Doig, A: Studies of nocturia in normal pregnancy. J Obstet Gynaecol Br Commonw 1973;80:888–895.
Cutner, A, Carey, A, Cardozo, LD: Lower urinary tract symptoms in early pregnancy. Br J Obstet Gynaecol 1992;12:75–78.
Stanton, SL, Kerr-Wilson, R, Harris, VG: The incidence of urological symptoms in normal pregnancy. Br J Obstet Gynaecol 1980;87:897–900.
Myers, DL, Scotti, RJ: Acute urinary retention and the incarcerated, retroverted, gravid uterus. J Reprod Med 1995;40:487–490.
Cutner, A, Cardozo, LD, Benness, CJ: Assessment of urinary symptoms in early pregnancy. Br J Obstet Gynaecol 1991;98:1283–1286.
Chaliha, C, Kalia, V, Stanton, SL, Monga, A, Sultan, AH: Antenatal prediction of postpartum urinary and fecal incontinence. Obstet Gynecol 1999;94: 689–694.
Chaliha, C, Kalia, V, Monga, A, Sultan, AH, Stanton, SL: Pregnancy, childbirth and delivery: A urodynamic viewpoint. Br J Obstet Gynaecol 2000;107: 1354–1359.
Viktrup, L, Lose, G, Rolff, M, Barfoed, K: The symptom of stress incontinence caused by pregnancy or delivery in primiparas. Obstet Gynecol 1992;79: 945–949.
Cutner, A, Cardozo, LD, Benness, CJ: Assessment of urinary symptoms in the second half of pregnancy. Int Urogynecol J 1992;3:30–32.
Cutner, A, Cardozo, LD, Benness, CJ, Carey, A, Cooper, D: Detrusor instability in early pregnancy. Neurourol Urodyn 1990;9:328–329.
Viktrup, L, Lose, G, Rolff, M, Barfoed, K: The frequency of urinary symptoms during pregnancy and puerperium in the primipara. Int Urogynecol J 1993;4:27–30.
Allen, RE, Hosker, GL, Smith, ARB, Warrell, DW: Pelvic floor damage and childbirth: A neurophysiological study. Br J Obstet Gynaecol 1990;97:770–779.
Cutner, A, Cardozo, LD: The lower urinary tract in pregnancy and the puerperium. Int Urogynecol J 1992;3:317–323.
Iosif, S, Ulmsten, U: Comparative urodynamic studies of continent and stress-incontinent women in pregnancy and the puerperium. Am J Obstet Gynecol 1981;140:645–650.
Wilson, PD, Herbison, RM, Herbison, GP: Obstetric practice and the prevalence of urinary incontinence. Br J Obstet Gynaecol 1996;103:154–161.
Van, Geelen JM, Lemmens, WA, Eskes, TK, Martin, CB Jr: The urethral pressure profile in pregnancy and after delivery in healthy nulliparous women. Am J Obstet Gynecol. 1982 Nov;144(6):636–649.
Snooks, SJ, Swash, M, Setchell, M, Henry, MM: Injury to the innervation of pelvic floor sphincter musculature in childbirth. Lancet 1984;2:546–550.
Peschers, USchaer, G, Anthuber, C, Delancey, JOL, Schuessler, B: Changes in vesical neck mobility following vaginal delivery. Obstet Gynecol 1996;88:1001–1006.
Meyer, S, Schreyer, A, De, Grandi P, Hohlfeld, P: The effects of birth on urinary continence mechanisms and other pelvic floor characteristics. Obstet Gynecol 1998;92:613–618.
Mittal, P, Wing, DA: Urinary tract infections in pregnancy. Clin Perinatol 2005;32:749–764.
Hill, JB, Sheffield, JS, McIntire, DD, Wendel, GD Jr: Acute pyelonephritis in pregnancy. Obstet Gynecol 2005;105:18–23.
Horowitz, E, Schmidt, JD: Renal calculi in pregnancy. Clin Obstet Gynecol 1985;28:324–338.
Drago, JR, Rohner, TJ Jr: Management of urinary calculi in pregnancy. Urology 1982;20:578–581.
Lattanzi, DR, Cook, WA: Urinary calculi in pregnancy. Obstet Gynecol 1980;56:462–466.
Demby AM, Schmidt JD: Urinary calculi in pregnancy. In: Buchsbaum, HJ, Schmidt, JD (eds): Gynecologic and Obstetric Urology. Philadelphia: WB Saunders, 1992: pp. 691–703.
Gertner, JM, Coustan, DR, Kliger, AS, Mallette, , Ravin, N, Broadus, AE: Pregnancy as a state of physiologic absorptive hypercalciuria. Am J Med 1986;81(3):451–456.
Nakagawa, Y, Abram, V, Parks, JH, Lau, HS, Kawooya, JK, Coe, FL: Urine glycoprotein crystal growth inhibitors: Evidence for a molecular abnormality in calcium oxalate nephrolithiasis. J Clin Invest 1985;76:1455–1462.
Harris, RE, Dunnihou, DR: The incidence and significance of urinary calculi in pregnancy. Am J Obstet Gynecol 1967;99:237–241.
Honore, : The increased incidence of renal stones in women with spontaneous abortion: A retrospective study. Am J Obstet Gynecol 1980; 137:145–146.
Waltzer, WC: The urinary tract in pregnancy. J Urol 1981;125:271–276.
Stothers, L, Lee, LM: Renal colic in pregnancy. J Urol 1992;148:1383–1387.
Hendricks, SK, Ross, SO, Krieger, JN: An algorithm for diagnosis and therapy of management and complications of urolithiasis during pregnancy. Obstet Gynecol 1991;172:49–54.
MacNeily, AE, Goldenberg, SL, Allen, GJ, Ajzen, SA, Cooperberg, PL: Sonographic visualization of the ureter in pregnancy. J Urol 1991;146:298–301.
McAleer, SJ, Loughlin, KR: Nephrolithiasis and pregnancy. Curr Opin Urol 2004;14:123–127.
Vieweg, J, Weber, HM, Miller, K, Hautmann, R: Female fertility following extracorporeal shock wave lithotripsy of distal ureteral calculi. J Urol 1992;148:1007–1010.
Vogel, H: Risiken der Rontgendiagnostik. Munich: Urban & Schwarzenberg, 1986: pp. 193–196.
Loughlin, KR, Bailey, BBJ: Internal ureteral stents for conservative management of ureteral calculi during pregnancy. N Engl J Med 1986;315:1647–1649.
Rittenberg, MH, Bagley, DH: Ureteroscopic diagnosis and treatment of urinary calculi during pregnancy. Urology 1988;32:427–428.
Denstedt, JD, Raxui, H: Management of urinary calculi during pregnancy. J Urol 1992;148:1072– 1075.
Weber HN, Dillon RW, Sotolongo JR: Urologic complications in pregnancy. In: Cherry SH, Merkatz IR, Wayne RC (eds): Cherry and Merkatz's Complications of Pregnancy. Philadelphia: Williams & Wilkins, 2000: pp. 536–559.
Goldfarb, RA, Neerhut, GJ, Lederer, E: Management of acute hydronephrosis of pregnancy by ureteral stenting: Risk of stone formation. J Urol 1989;141: 921–922.
Wolf, MC, Hollander, JB, Salisz, JA, Kearney, DJ: A new technique for ureteral stent placement during pregnancy using endoluminal ultrasound. Surg Gynecol Obstet 1992;175:575–576.
Vest, JM, Warden, SS: Ureteroscopic stone manipulation during pregnancy. Urology 1990;35:250–252.
Kramolowsky, EV: Ureteral perforation during ureteroscopy: Treatment and management. J Urol 1987;138:36–38.
Khoo, L, Anson, K, Patel, U: Success and short-term complication rates of percutaneous nephrostomy during pregnancy. J Vasc Interv Radiol 2004;15:1469–1473.
Kavoussi, LR, Albala, DM, Basler, JW, Apte, S, Clayman, RV: Percutaneous management of urolithiasis during pregnancy. J Urol 1992;148:1069–1071.
Rodriguez, SU, Leikin, SL, Hiller, MC: Neonatal thrombocytopenia associated with antepartum administration of thiazide drugs. N Engl J Med 1964;270:881–884.
Gray, MJ: Use and abuse of thiazides in pregnancy. Clin Obstet Gynecol 1968;11:568–578.
Eckford, SD, Gingell, JC: Ureteric obstruction in pregnancy – diagnosis and management. Br J Obstet Gynaecol 1991;98:1137–1140.
Hess, LW, Nolan, TE, Martin, RW, Martin, JN Jr, Wiser, WL, Morrison, JC: Incarceration of the retroverted gravid uterus: Report of four patients managed with uterine reduction. South Med J 1989;82:310–312.
Silva, PD, Berberich, W: Retroverted impacted gravid uterus with acute urinary retention: Report of two cases and a review of the literature. Obstet Gynecol 1986;68:121–123.
Herzig N: Urologic problems of labor and delivery. In: Freed, SZ, Herzig, N (eds): Urology in Pregnancy. Baltimore: Williams & Wilkins, 1982: pp. 208–215.
Hée, P, Lose, G, Beier-Holgersen, R, Engdahl, E, Falkenl⊘ve, P: Postpartum voiding in the primiparous after vaginal delivery. Int Urogynecol J 1992; 3:95–99.
Anderson, GW, Rice, GG, Harris, BA Jr: Pregnancy and labor complicated by pelvic ectopic kidney. J Urol 1951;65:760–776.
Anderson, GW, Rice, GG, Harris, BA Jr: Pregnancy and labor complicated by pelvic ectopic kidney anomalies. Obstet Gynecol Surv 1949;4:737–773.
Newton M, Newton ER: Surgical problems in pregnancy. In: Sciarra, JJ, Speroff, L, Simpson, JY (eds): Gynecology and Obstetrics. Philadelphia: JB Lippincott, 1991; 4: pp. 1–11.
Buchsbaum, HJ: Accidental injury complicating pregnancy. Am J Obstet Gynecol 1968;102:752–769.
Orkin LA: Trauma to the bladder, ureter, and kidney. In: Sciarra, JJ, Speroff, L, Simpson, JL (eds): Gynecology and Obstetrics. Philadelphia: JB Lippincott, 1991; 1: pp. 1–8.
Perry, MO, Husmann, DA: Urethral injuries in female subjects following pelvic fracture. J Urol 1992;147:139–143.
Hassim, AM: Rupture of a diverticulum of the uterus. Am J Obstet Gynecol 1968;101:1132–1134.
Rendle-Short, CW: Rupture of gravid uterus in Uganda. Am J Obstet Gynecol 1960;79:1114–1120.
Raghavaiah, NV, Devi, AI: Bladder injury associated with rupture of the uterus. Obstet Gynecol 1975; 46:573–576.
Cunningham, G, Gant, NF, Leveno, KJ, Gilstrap, L C, Hauth, J C, Wenstrom, KD: Williams Obstetrics, ed 22. New York: McGraw-Hill, 2005: pp. 423– 563.
Klotz, PG, Khalaff, HM: Placenta percreta invading the bladder: Report of two cases. J Urol 1989;141: 938–939.
Taefi, P, Kaiser, TF, Sheffer, JB, Courney, NG, Hodson, JM: Placenta percreta with bladder invasion and massive hemorrhage: Report of a case. Obstet Gynecol 1970;36:686–687.
Mattingly, RF, Borkowf, HI: Acute operative injury to the lower urinary tract. Clin Obstet Gynecol 1978;5:123–147.
Loughlin, KR: Management of urologic problems during pregnancy. Urology 1994;44:159–169.
Faricy, PO, Augspurger, RR, Kaufman, JM: Bladder injuries associated with cesarean sections. J Urol 1978: 120:762–763.
Plauché, WC, Wycheck, JG, Iannessa, MJ, Roussett, KM, Mickal, A: Cesarean hysterectomy at Louisiana State University, 1975 through 1981. South Med J 1983;76:1261–1263.
Plauché WC: Peripartal hysterectomy. In: Plauché, WC, Morrison, JC, O'Sullivan, MJ (eds): Surgical Obstetrics. Philadelphia: WB Saunders, 1992: pp. 447–465.
Youssef, AF: “Menuria” following lower segment cesarean section. Am J Obstet Gynecol 1957;73: 759–767.
Plauché WC: Obstetric genital trauma. In: Plauché, WC, Morrison, JC, O'Sullivan, MJ (eds): Surgical Obstetrics. Philadelphia: WB Saunders, 1992: pp. 383–404.
Gerber, GS, Schoenberg, HW: Female urinary tract fistulas. J Urol 1993;149:229–236.
Hilton P: Obstetric fistulae. In: Cardozo, L, Staskin, D (eds): Textbook of Female Urology and Urogynaecology. London: Isis Medical Media Ltd, 2001: pp. 711–719.
Hilton P: Surgical fistulae. In: Cardozo, L, Staskin, D (eds): Textbook of Female Urology and Urogynaecology. London: Isis Medical Media Ltd, 2001: pp. 691–709.
Gangai, MD: An unusual surgical injury to the ureter. J Urol 1973;109:32.
Dimopoulos, C, Giannopoulos, A, Pantasopoulos, D, Vlahos, L: Avulsion of the ureter from both ends as a complication of interruption of pregnancy with vacuum aspirator. J Urol 1977;118:108.
Yasin SY, Walton, DL, O'Sullivan MJ: Problems encountered during cesarean delivery. In: Plauché, WC, Morrison, JC, O'Sullivan, MJ (eds): Surgical Obstetrics. Philadelphia: WB Saunders, 1992: pp. 431–445.
Landau, SY: Ureteroneocystostomy: A review of 72 cases with a comparison of two techniques. J Urol 1962;87:343–349.
Hodges, CV, Moore, RJ, Lehman, TH: Clinical experiences with transureteroureterostomy. J Urol 1963;90:552–562.
Matthews, R, Marshall, FF: Versatility of the adult psoas hitch ureteral reimplantation. J Urol 1997;158:2078–2082.
Konigsberg, H, Blunt, KJ, Muecke, EC: Use of Boari flap in lower ureteral injuries. Urology 1975;5:751–755.
Benson, MC, Ring, KS, Olsson, CA: Ureteral reconstruction and bypass: Experience with ileal interposition, the Boari flap-psoas hitch and renal autotransplantation. J Urol 1990;143:20–23.
Dowling, RA, Corriere, JN Jr, Sandler, CM: Iatrogenic ureteral injury. J Urol 1981;135:912–915.
Hardy, JD: High ureteral injuries: Management by autotransplantation of the kidney. JAMA 1963; 184:97–101.
Moran, PA, Carey, MP, Dwyer, PL: Urethral diverticula in pregnancy. Aust N Z J Obstet Gynaecol 1998;38:102–106.
Allen, , Mount, J, Cline, D, Mertz, JH: Pelvic dystocia secondary to urethral diverticulum and urinary retention. J Urol 1969;102:451–453.
Roxe DM: Renal disease in pregnancy. In: Sciarra, JJ, Speroff, L, Simpson, JL (eds): Gynecology and Obstetrics. Philadelphia: JB Lippincott, 1991; 3: pp. 1–16.
Doyle, BA, Smith, SP, Stempel, : Urinary undiversion and pregnancy. Am J Obstet Gynecol 1988; 158:1131–1132.
Hill, , Kramer, SA: Management of pregnancy after augmentation cystoplasty. J Urol 1990;144:457–459.
Fenn, N, Barrington, JW, Stephenson, TP: Clam enterocystoplasty and pregnancy. Br J Urol. 1995;75:5–6.
Fishman, IJ, Scott, FB: Pregnancy in patients with the artificial urinary sphincter. J Urol 1993;150:340–341.
Petrou, SP, Elliott, DS, Barrett, DM: Artificial urethral sphincter for incontinence. Urology 2000; 56:353–359.
Toh, K, Diokno, AC: Management of intrinsic sphincter deficiency in adolescent females with normal bladder emptying function. J Urol 2002;168: 1150–1153.
Cutner, A, Cardozo, LD, Wise, BG: The effects of pregnancy on previous incontinence surgery: Case report. Br J Obstet Gynaecol 1991;98:1181–1183.
Dainer, M, Hall, CD, Choe, J, Bhatia, N: Pregnancy following incontinence surgery. Int Urogynecol J Pelvic Floor Dysfunct 1998;9:385–90.
Atherton, MJ, Stanton, SL: The tension-free vaginal tape reviewed: An evidence-based review from inception to current status. Br J Obstet Gynaecol 2005;112:534–546.
Shindel, AW, Klutke, CG: Urethral slings placed by the transobturator approach: Evolution in the technique and review of the literature. Curr Urol Rep 2005;6:385–392.
Gauruder-Burmester, A, Tunn, R: Pregnancy and labor after TVT-plasty. Acta Obstet Gynecol Scand 200;80:283–284.
Seeger, D, Truong, ST, Kimmig, R: Spontaneous delivery following tension-free vaginal tape procedure. Int Urogynecol J Pelvic Floor Dysfunct 2006;17:676–678.
Volkmer, BG, Seidl, EM, Gschwend, JE, Petriconi, R, Bach, D, Kleinschmidt, K: Pregnancy in women with ureterosigmoidostomy. Urol. 2002;60:979–982.
Gontero, P, Masood, S, Sogni, F, Fontana, F, Mufti, G, Frea, B: Upper urinary tract complications in pregnant women with an ileal conduit: Lessons learned from two cases. Scand J Urol Nephrol 2004;38:523–524.
Austenfeld, MS, Snow, BW: Complications of pregnancy in women after reimplantation for vesicoureteral reflux. J Urol 1988;140:1103–1106.
Mansfield, JT, Snow, BW, Cartwright, PC, Wadsworth, K: Complications of pregnancy in women after childhood reimplantation for vesicoureteral reflux: An update with 25 years of followup. J Urol 1995;154:787–790.
Mor, Y, Leibovitch, I, Zalts, R, Lotan, D, Jonas, P, Ramon, J: Analysis of the long-term outcome of surgically corrected vesico-ureteric reflux. BJU International 2003;92:97–100.
Mor, Y, Leibovitch, I, Fridmans, A, Farkas, A, Jonas, P, Ramon, J: Late post-reimplantation ureteral obstruction during pregnancy: A transient phenomenon?J Urol 2003;170:845–848.
Derus JA, Begun FP, Jacobs SC: Genitourinary malignancies in pregnancy. In: Buchsbaum, HJ, Schmidt, JD (eds): Gynecologic and Obstetric Urology. Philadelphia: WB Saunders, 1993: pp. 705–713.
Gonzalez-Blanco, S, Mador, DR, Vickar, DB, McPhee, MS: Primary bladder carcinoma presenting during pregnancy in 3 cases. J Urol 1989;141:613–614.
Malamud SC, Holland JP: Neoplasia and pregnancy. In: Cherry, SH, Merkatz, IR, Wayne, RC (eds): Cherry and Merkatz's Complications of Pregnancy. Philadelphia: Williams & Wilkins, 2000: pp. 638–661.
Spahn, M, Bader, P, Westermann, D, Echtle, D, Frohneberg, D: Bladder carcinoma during pregnancy. Urol Int 2005;74:153–159.
Wai, CY, Miller, DS: Urinary bladder cancer. Clin Obstet Gynecol 2002;45:844–854.
Lurie, A, Eisenkraft, SH, Shotland, Y, Lurie, M: Mucin-producing adenocarcinoma of the bladder of urachal origin. Urol Int 1983;38:12–15.
Williams, SF, Bitran, JD: Cancer and pregnancy. Clin Perinatol 1985;12:609–623.
Fehrenbaker, LG, Rhodes, JC, Derby, DR: Transitional cell carcinoma of bladder during pregnancy: Case report. J Urol 1972;108:419–420.
O'Connor, JP, Biyani, CS, Taylor, J, Agarwal, V, Curley, PJ, Browning, AJ: Laparoscopic nephrectomy for renal-cell carcinoma during pregnancy. J Endourol 2004;18:871–874.
Sainsbury, DC, Dorkin, TJ, MacPhail, S, Soomro, NA: Laparoscopic radical nephrectomy in first-trimester pregnancy. Urology 2004;64:1231.e7–e8.