Urological issues in pregnancy: A review for urologists

Abstract

Urological issues in the pregnant patient present a unique clinical dilemma. These patients may be challenging to treat due to risks associated with medications and surgical procedures. This review aims to provide an update on the physiological changes and surgical risks in pregnancy. In addition, we review the approach for management of urolithiasis and urinary tract infections (UTIs) in pregnancy. Lastly, we highlight the importance of a multidisciplinary approach to placenta percreta, a condition not commonly addressed in urological education.

Live donor nephrectomy side: Is it implicated in urologic complications among lady donors during their post-donation pregnancies?

“…In addition, there was a report on a young lady who got pregnant shortly after undergoing left donor nephrectomy with subsequent acute kidney injury late during pregnancy presumably due to pregnancy-related right hydronephrosis [8]. More than half of pregnant ladies develop hydronephrosis late during pregnancy due to both mechanical and hormonal causes [9]. Hydronephrosis is more pronounced on the right side due to different anatomy of the right compared to the left ureter making the right ureter more liable to compression as it crosses the iliac artery at the pelvic brim and crossed by the right ovarian vein, compression by the dextrorotated uterus and crossing right ovarian vein and protection of the left ureter by the gas-lled sigmoid colon [10,11] .However, laterality difference in terms of urologic complications during pregnancy is rarely evaluated [8,11].…”

“…The rationale behind this policy is the belief that if pregnancy occurs after donation, female kidney donors with a solitary right kidney will be subjected to more urologic complications compared to those with a solitary left kidney. This belief is based on the well-known information that hydronephrosis during pregnancy is more pronounced on the right side [2]. Nevertheless, such practice may create an extra-pressure on the transplant team especially in the context of the rapidly growing minimally invasive donor nephrectomy technique in which right nephrectomy is generally not preferred [3].…”

Urine collection devices to reduce contamination in urine samples for diagnosis of uncomplicated UTI: a single-blind randomised controlled trial in primary care

“…Planned subgroup analyses were performed for women who were post-menopausal, pregnant, or had a history of recurrent UTI. These groups are suggested to have physiological changes in the urinary tract [13][14][15] which might have the potential to alter either the proportion of samples which are contaminated or device performance. We compared samples received ≤ 48 hours and > 48 hours after provision to explore the potential impact of duration of storage and transport on our findings.…”

Canadian Urological Association guideline: Management of ureteral calculi

“…Although safe, the evidence for NT placement are comprised of small low-level studies. [221][222][223] In pregnancy, ureteral stents and NTs are at risk for accelerated encrustation thereby requiring changes every 4-6 weeks. 224,225 Failing conservative management, URS using laser lithotripsy has been shown to be feasible and safe.…”

“…227,234 With respect to safety of the pregnancy, traditional teaching was that URS should be undertaken during the second trimester, 220,235 but more recent literature suggests there is no evidence to support a "safest" trimester. 221 With regards to intraoperative imaging, if URS or ureteral stent insertion is undertaken, then a lead apron or shield should be put between the x-ray fluoroscopy source and the fetus to shield it from radiation. 236 Alternatively, URS or ureteral stent insertion can be performed under ultrasound guidance alone, avoiding radiation exposure.…”