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Seat M, Boxwalla M, Hough A, Goodwin G. A case of congenital cloacal exstrophy/omphalocele-exstrophy-imperforate anus-spinal defects syndrome and a successful pregnancy. Clin Exp Reprod Med 2022; 49:215-218. [PMID: 36097738 PMCID: PMC9468692 DOI: 10.5653/cerm.2021.05148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/15/2022] [Indexed: 11/30/2022] Open
Abstract
Herein, we report an exceptionally rare case of a 25-year-old woman with cloacal exstrophy/omphalocele-exstrophy-imperforate anus-spinal defects (OEIS) syndrome achieving a viable pregnancy despite many gastrointestinal and genitourinary malformations and multiple respective corrective operations. The patient was born with two vaginas, two uteruses, four ovaries, an imperforate anus, a large omphalocele including bowel and bladder exstrophy, and diaphysis of the pubic rami. This patient is the only documented OEIS patient not to have tethered spinal cord as an anomaly, perhaps contributing to her successful pregnancy. After experiencing preeclampsia with severe features at 35 weeks, the baby was born via cesarean section.
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Affiliation(s)
- Mara Seat
- Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA
- Corresponding Author: Mara Seat Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, 3200 S University Dr, Fort Lauderdale, FL 33328, USA Tel: +1-94-1330-6938 E-mail:
| | - Munira Boxwalla
- Department of Obstetrics and Gynecology, Staten Island University Hospital, Staten Island, NY, USA
| | - Arielle Hough
- Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Glenn Goodwin
- Department of Emergency Medicine, Aventura Hospital and Medical Center, Miami, FL, USA
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Tong CMC, Dew ME, Zimmerman KD, Hopson BD, Blount JP, Rocque BG, Arynchyna A, Wilson T, Joseph D, Dangle P, Powell D, McLain A. A qualitative interview study on successful pregnancies in women with spina bifida. J Pediatr Urol 2022; 18:3.e1-3.e7. [PMID: 34862130 DOI: 10.1016/j.jpurol.2021.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 08/31/2021] [Accepted: 10/31/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Improvements in antenatal medicine and surgical management for conditions associated with spina bifida such as hydrocephalus have extended the lifespan for individuals with spina bifida (SB) into adulthood. Decisions and education regarding reproductive care and pregnancies for patients with spina bifida are increasingly important. Pregnancy in these patients can be particularly challenging due to physical limitations, previous abdominal surgery for urinary or bowel management and presence of a ventriculoperitoneal shunt. To date, little research has examined the unique challenges that women with spina bifida face during pregnancy. OBJECTIVE The purpose of this descriptive study is to characterize the successful pregnancy histories of SB women and describe how pregnancy affected their mobility as well as bladder and bowel management. STUDY DESIGN We conducted semi-structured interviews with women followed in our adult multidisciplinary SB clinic who previously had successful pregnancies. Questions regarding perinatal issues, obstetrical complications, urinary tract infections (UTI) and neurological changes were asked. Baseline mobility, bladder and bowel management were compared with changes during and after pregnancy. RESULTS 121 women of childbearing age were followed per year by our adult multidisciplinary spina bifida clinic between 2009 and 2016. We identified 6 women who successfully carried 8 pregnancies to term. There were no miscarriages. Four women had ventriculoperitoneal (VP) shunts. No children were born with neural tube defects. Mean age at first pregnancy was 23.5 years. Average gestational age at delivery was 37 weeks. 50% of the women had a spontaneous vaginal delivery. Five of six women intended to get pregnant; only one patient consumed folic acid regularly prior to pregnancy. Two of six women had bladder augmentation surgery, one of whom had urologic changes during pregnancy that persisted after childbirth. The other patient had a concomitant bladder neck sling procedure and did not have urologic issues during pregnancy. 50% of the patients experienced bladder-bowel dysfunction during their pregnancy. While 67% patients had full baseline ambulatory function, 4 patients had decreased mobility and required additional assistance during pregnancy. All returned to their baseline functionality afterwards. CONCLUSION Six of our patients had eight successful pregnancies, with no children born with neural tube defects. New changes to mobility, bladder and bowel management were experienced by over half of the women during their pregnancies. Future studies should focus on the role of multidisciplinary teams in reproductive health education and perinatal management of changes to activities of daily living during pregnancy in this population.
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Affiliation(s)
| | - Morgan E Dew
- Department of Neurosurgery, University of Alabama at Birmingham, United States
| | - Kathrin D Zimmerman
- Department of Neurosurgery, University of Alabama at Birmingham, United States
| | - Betsy D Hopson
- Department of Neurosurgery, University of Alabama at Birmingham, United States
| | - Jeffrey P Blount
- Department of Neurosurgery, University of Alabama at Birmingham, United States
| | - Brandon G Rocque
- Department of Neurosurgery, University of Alabama at Birmingham, United States
| | - Anastasia Arynchyna
- Department of Neurosurgery, University of Alabama at Birmingham, United States
| | - Tracey Wilson
- Department of Urology, University of Alabama at Birmingham, United States
| | - David Joseph
- Department of Urology, University of Alabama at Birmingham, United States
| | - Pankaj Dangle
- Department of Urology, University of Alabama at Birmingham, United States
| | - Danielle Powell
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, United States
| | - Amie McLain
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, United States
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Abstract
Women and girls with spina bifida have specific health care concerns. It is essential that they, and their health care providers have access to information to help them make healthy choices throughout their lifespan. This article aims to address key aspects of health pertinent to girls and women with spina bifida and outlines the SB Women's Health Guidelines for the Care of People with Spina Bifida. Further research into this area is needed.
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Affiliation(s)
- Anne Berndl
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Toronto, Toronto, ON, Canada
| | - Margaret Nosek
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Huston, TX, USA
| | - Ashley Waddington
- Department of Obstetrics and Gynecology, Queen’s University, Kingston, ON, Canada
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Bey E, Perrouin-Verbe B, Reiss B, Lefort M, Le Normand L, Perrouin-Verbe MA. Outcomes of pregnancy and delivery in women with continent lower urinary tract reconstruction: systematic review of the literature. Int Urogynecol J 2021; 32:1707-1717. [PMID: 34125241 DOI: 10.1007/s00192-021-04856-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/09/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this systematic review of the literature was to pool all the existing data regarding pregnancy and delivery in women with neurogenic bladder or bladder exstrophy who had undergone previous lower urinary tract reconstruction (LUTR). METHODS We conducted a systematic review of the literature from PubMed/MedLine, ClinicalTrials.gov and the Google Scholar database, from 1972 to July 2020. Fifty articles were included, of which 25 contained data that could be pooled (229 women representing 292 pregnancies). RESULTS Ninety-eight women had bladder exstrophy (43%), 58 had spinal dysraphism (25%), 14 had spinal cord injury (6%), and 59 presented other pathological conditions. Of these, 138 have had an augmentation cystoplasty (61%), 42 (18%) had a continent cutaneous urinary diversion, and 31 had an artificial urinary sphincter (14%). During their pregnancy, 97 women (33%) experienced at least one febrile urinary tract infection. Thirty-one women (11%) required ureteral stenting or nephrostomy placement for upper urinary tract dilatation. Forty-six pregnancies ended with premature delivery (16%). Delivery mode was by C-section for 108 patients (62%) and vaginal delivery for 104 (36%). Twenty complications were reported during delivery (mainly urological), of which 19 occurred during C-section. Nine women experienced postpartum urinary incontinence (4%); in 5 of then this was due to urinary fistulae secondary to complicated C-section. CONCLUSIONS Pregnancy and vaginal delivery are possible for women with LUTR who have no obstetric or medical contraindications, except for some particular cases of bladder exstrophy. However, these high-risk pregnancies and deliveries should be managed by a specialist multidisciplinary team.
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Affiliation(s)
- Elsa Bey
- Department of Urology, CHU-Université de Nantes, 1 place Alexis Ricordeau, 44000, Nantes, France.
| | - Brigitte Perrouin-Verbe
- Physical Medicine and Rehabilitation Department, CHU-Université de Nantes, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - Bénédicte Reiss
- Physical Medicine and Rehabilitation Department, CHU-Université de Nantes, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - Marc Lefort
- Physical Medicine and Rehabilitation Department, CHU-Université de Nantes, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - Loïc Le Normand
- Department of Urology, CHU-Université de Nantes, 1 place Alexis Ricordeau, 44000, Nantes, France
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Quiroz Y, Llorens E, Novoa R, Motta G, Llurba E, Porta O, Parra J, Ballarin J, Palou J, Bujons A. Pregnancy in Pateints With Exstrophy-Epispadias Complex: Are Higher Rates of Complications and Spontaneous Abortion Inevitable? Urology 2021; 154:326-332. [PMID: 33662406 DOI: 10.1016/j.urology.2021.01.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report on the characteristics of pregnancy in female patients with EEC (exstrophy-epispadias complex), determining in particular whether they are at higher risk of spontaneous abortion or complications. MATERIALS AND METHOD Fifty patients diagnosed with EEC and treated in a reference center for this pathology were reviewed. Those with an incomplete medical history were excluded, leaving a total of 37 women with a median follow-up of 26 years (1-48 years). The outcome measurements were successful pregnancies, miscarriages, urological, gynecological and obstetric complications, impaired renal function, newborn characteristics, and postpartum urogynecological complications. Descriptive statistics was used. RESULTS Eight patients achieved 17 pregnancies (88.2% spontaneous). Of these pregnancies, 10 (58.8%) were successful, while 7 (41.2%) terminated in miscarriages. Urinary tract infection (UTI) was the most frequent complication (41.6%) and intestinal occlusion was the most severe. A total of 62.5% of the patients presented genital prolapses after pregnancies. A total of 85.7% of patients were dry during the follow-up after their pregnancies. No newborn presented EEC or any other type of malformation. Our study has the limitation of being a retrospective review of a very heterogeneous and small group of patients. CONCLUSION EEC patients can achieve spontaneous pregnancies but have an increased risk of miscarriage. For this reason, monitoring and control by a specialized and integrated multidisciplinary team is required to minimize complications.
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Affiliation(s)
- Yesica Quiroz
- Urology Department, Fundació Puigvert, Barcelona, Spain
| | - Erika Llorens
- Urology Department, Fundació Puigvert, Barcelona, Spain
| | - Rosa Novoa
- Urology Department, Fundació Puigvert, Barcelona, Spain
| | | | - Elisa Llurba
- Gynecology and Obstetrics Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Oriol Porta
- Gynecology and Obstetrics Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Juan Parra
- Gynecology and Obstetrics Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jose Ballarin
- Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - Joan Palou
- Urology Department, Fundació Puigvert, Barcelona, Spain
| | - Anna Bujons
- Urology Department, Fundació Puigvert, Barcelona, Spain.
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Let's Talk About Sex: Special Considerations in Reproductive Care and Sexual Education in Young Women With Spina Bifida. Urology 2020; 151:79-85. [PMID: 32692989 DOI: 10.1016/j.urology.2020.05.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/05/2020] [Accepted: 05/17/2020] [Indexed: 11/22/2022]
Abstract
Medical advances in the last several decades have allowed an increasing number of children with spina bifida to reach adolescence and adulthood. As they reach puberty, girls with spina bifida face unique social and health challenges to their sexuality, such as orthopedic restrictions, continence, and pelvic floor disorders. Recent research efforts have focused on better understanding female sexual desires, dysfunctions, and activity and the role of the physician in educating this vulnerable population. This article aims to summarize current literature on sexual function, knowledge gaps, and the importance of tailored sexual education from providers in women with spina bifida.
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Vilanova-Sanchez A, McCracken K, Halleran DR, Wood RJ, Reck-Burneo CA, Levitt MA, Hewitt G. Obstetrical Outcomes in Adult Patients Born with Complex Anorectal Malformations and Cloacal Anomalies: A Literature Review. J Pediatr Adolesc Gynecol 2019; 32:7-14. [PMID: 30367985 DOI: 10.1016/j.jpag.2018.10.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 12/22/2022]
Abstract
Patients born with complex anorectal malformations often have associated Müllerian anomalies, which might affect fertility and obstetrical outcomes. Other vertebral-anorectal-tracheoesophageal-renal-limb associations, such as renal or cardiac anomalies, could also affect pregnancy intention, fertility rates, and recommendations about mode of delivery or obstetrical outcomes. Associated conditions present at birth, like hydrocolpos, could also potentially affect fertility. Depending on the complexity of the anomaly, primary reconstruction might include vaginoplasty, vaginal interposition, perineal body reconstruction, and extensive pelvic dissection. After the initial reconstruction, patients might have multiple additional surgeries for stoma reversal, bladder augmentation, and creation of conduits, all with potential for pelvic adhesions. Pregnancy intention, fertility rates, mode of delivery, and obstetrical outcomes data are limited in this patient population, making it challenging to counsel patients and their families. We sought to evaluate all available literature in an attempt to better counsel families. A PubMed literature search was undertaken to review this topic. Search terms of "cloaca," "anorectal malformation," "pregnancy," "cloacal exstrophy," "vaginal delivery," and "cesarean section" were used and citation lists from all identified articles were checked to ensure that all possible articles were included in the review. We also outline comorbidities from the fetal period to adulthood that might affect reproductive health. Of the articles on anorectal and cloacal anomalies, 13 reports were identified that covered obstetrical outcomes. They were in patients with previous anorectal malformation, cloaca, and cloacal exstrophy repair. Twenty-four pregnancies were reported in 16 patients. Two ectopic pregnancies, 5 spontaneous miscarriages, 1 triplet pregnancy, and 16 singleton pregnancies were reported with a total of 19 live births. Regarding the method of conception, 15/18 pregnancies occurred spontaneously and 3/18 were via assisted reproductive technology with in vitro fertilization. There were 19 live births, of which at least 8 were preterm. Müllerian anatomy was reported in 8 of 13 articles. Only 2 patients underwent vaginal delivery (1 patient with repaired cloaca malformation had an operative vaginal delivery and 1 patient with repaired imperforate anus with rectovaginal fistula had a normal spontaneous vaginal delivery). The remaining patients all underwent a cesarean section. There were no reported cases of maternal mortality, and maternal morbidity was limited to recurrent urinary tract infections and worsening chronic kidney disease. There is a paucity of information regarding obstetrical outcomes in adult anorectal and cloaca patients. However, patients with previous cloacal repairs have achieved pregnancy spontaneously, as well as with in vitro fertilization. Patients with repaired cloacal malformations are at increased risk of preterm birth and cesarean delivery. Most patients with cloacal anomalies have an associated Müllerian anomaly and therefore have an increased risk of preterm labor. From our review we conclude that contraception should be offered to patients not desiring pregnancy, and cesarean section is likely the preferred mode of delivery. On the basis of this review, we recommend proactive data collection of all such patients to document outcomes and collaboration among providers and between centers devoted to this complex patient population.
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Affiliation(s)
| | | | | | | | | | | | - Geri Hewitt
- Nationwide Children's Hospital, Columbus, Ohio
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Shepard CL, Yan PL, Kielb SJ, Wittmann DA, Quint EH, Kraft KH, Hollingsworth JM. Complications of Delivery Among Mothers With Spina Bifida. Urology 2018; 123:280-286. [PMID: 29908216 DOI: 10.1016/j.urology.2018.04.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/11/2018] [Accepted: 04/20/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To determine rates and types of peripartum morbidity among delivering women with spina bifida (SB) compared to those without SB. The rates of pregnancy and delivery among women with SB have been significantly increasing. Current knowledge of peripartum outcomes for these women is limited. METHODS Using 2004-2013 National Inpatient Sample data, we identified all hospitalizations for delivery, distinguishing between women with and without SB. Using a code-based algorithm, we determined whether a complication occurred during the hospitalization. We then fit a series of multivariable logistic models to examine for associations between a complication occurrence during vaginal or cesarean delivery and a woman's SB status. RESULTS We identified 38,319,814 weighted admissions for delivery, 9516 of which were made by women with SB. Women with SB had a significantly higher rate of cesarean delivery than women without this diagnosis (53% vs 32%, P < .001). The 46.7% of women with SB who delivered vaginally did not have significantly increased odds of a complication associated with their delivery compared to women without SB [odds ratio 1.15, 95% confidence interval 0.99-1.34, P = .066]. However, women with SB who underwent a cesarean delivery did have higher odds of morbidity compared to those without (odds ratio 1.49, 95% confidence interval 1.25-1.78, P < .001). Common complications included preterm delivery, urinary tract infection, hematologic event, and blood transfusion. CONCLUSION Compared to women without SB, those with SB deliver more frequently by cesarean section and have higher odds of morbidity associated with cesarean delivery, but not vaginal delivery.
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Affiliation(s)
- Courtney L Shepard
- Divisions of Pediatric Urology and Health Services Research, Department of Urology, University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor.
| | - Phyllis L Yan
- Divisions of Endourology and Health Services Research, Department of Urology, University of Michigan Institute for Health Policy and Innovation, Ann Arbor
| | - Stephanie J Kielb
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, Northwestern Medicine, Chicago
| | - Daniela A Wittmann
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| | - Elisabeth H Quint
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
| | - Kate H Kraft
- Divisions of Pediatric Urology and Endourology, Department of Urology, University of Michigan, Ann Arbor
| | - John M Hollingsworth
- Divisions of Endourology and Health Services Research, Department of Urology, University of Michigan Institute for Health Policy and Innovation, Ann Arbor
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Abstract
PURPOSE OF REVIEW Classic bladder exstrophy (BE) remains one of the most demanding reconstructive challenges encountered in urology. In female BE patients, the long-term sequela of both primary and revision genitoplasty, as well as intrinsic pelvic floor deficits, predispose adult women to significant issues with sexual function, pelvic organ prolapse (POP), and complexities with reproductive health. RECENT FINDINGS Contemporary data suggest 30-50% of women with BE develop prolapse at a mean age of 16 years. Most women will require revision genitoplasty for successful sexual function, although in some series over 40% report dyspareunia. Current management for pregnancy includes elective cesarean section with involvement of high-risk obstetrics and urologic surgery. This review encapsulates contemporary concepts of etiology, prevalence, and management of POP and pregnancy in the adult female BE patient.
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Affiliation(s)
- Melissa R Kaufman
- Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville, TN, 37232-2765, USA.
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10
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Abstract
INTRODUCTION Recognizing the importance of sexual and reproductive health to patients with spina bifida (SB), pediatric urologists have taken responsibility for initiating conversations regarding this topic with adolescent and young adult SB patients. However, the sexual and reproductive health of women with SB remains under-investigated. It is unknown how many women are having babies, what mode of delivery is used, and if this has changed over time with the increasing life expectancy of these patients. A better understanding of pregnancy and delivery among young women with SB will enable urologists to provide more informed, comprehensive counseling to patients. OBJECTIVE We sought to compare hospitalizations for delivery in women with and without SB to determine differences in the mode of delivery used and changes in the rate of deliveries over time. STUDY DESIGN Using the Healthcare Cost and Utilization's National Inpatient Sample, we identified all hospitalizations for delivery in 2003-2013. After distinguishing between hospitalizations among women with and without SB, temporal trends analysis and bivariate comparison were performed to determine differences in patient and hospital characteristics and mode of deliveries. RESULTS We identified 10,147 hospitalizations for deliveries among women with SB and 42,197,763 among women without. Of all hospitalizations for deliveries, the percentage of deliveries by women with SB increased by 56% between 2003 and 2013 (629-925 deliveries per year, p < 0.001). Women with SB hospitalized for a delivery differed from those without SB. They had a higher number of comorbidities and were more likely to be white, have Medicare or private insurance, live outside a city, and deliver at an urban teaching hospital (all p < 0.001). Women with SB were significantly more likely to undergo a caesarean section (see Figure, 52.4% of women with SB vs. 31.9% of those without, p < 0.001), although nearly half were able to undergo vaginal delivery. For women with SB, 25.9% of all deliveries occurred by age 22, which did not differ significantly from women without SB (24.7% of all deliveries). DISCUSSION There are significant differences in the characteristics and mode of delivery between women with and without SB who are hospitalized for a delivery. The number of deliveries among these women are significantly increasing and over a quarter of the deliveries occur by age 22. CONCLUSION With increasing rates of deliveries and young age at delivery for women with SB, it is imperative that pediatric and transitional urologists initiate discussions on sexual and reproductive health beginning in adolescence.
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Roth JD, Casey JT, Whittam BM, Szymanski KM, Kaefer M, Rink RC, Schubert FP, Cain MP, Misseri R. Complications and Outcomes of Pregnancy and Cesarean Delivery in Women With Neuropathic Bladder and Lower Urinary Tract Reconstruction. Urology 2018; 114:236-243. [PMID: 29305940 DOI: 10.1016/j.urology.2017.11.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/11/2017] [Accepted: 11/14/2017] [Indexed: 01/24/2023]
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.
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Affiliation(s)
- Joshua D Roth
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Jessica T Casey
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Benjamin M Whittam
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Konrad M Szymanski
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Martin Kaefer
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Richard C Rink
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | | | - Mark P Cain
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Rosalia Misseri
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN.
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Higuchi T, Holmdahl G, Kaefer M, Koyle M, Wood H, Woodhouse C, Wood D. International Consultation on Urological Diseases: Congenital Anomalies of the Genitalia in Adolescence. Urology 2016; 94:288-310. [DOI: 10.1016/j.urology.2016.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Singh N, Kriplani A, Mahey R, Kachhawa G. Management of narrow introitus with Fenton's operation followed by successful pregnancy in a woman with repaired bladder exstrophy. J OBSTET GYNAECOL 2014; 35:426. [PMID: 25188695 DOI: 10.3109/01443615.2014.954531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- N Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences , New Delhi , India
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14
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Update on Female Neurogenic Lower Urinary Tract Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-013-0221-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Giron AM, Passerotti CC, Nguyen H, Cruz JASD, Srougi M. Bladder exstrophy: reconstructed female patients achieving normal pregnancy and delivering normal babies. Int Braz J Urol 2012; 37:605-10. [PMID: 22099272 DOI: 10.1590/s1677-55382011000500006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2011] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Bladder exstrophy (BE) is an anterior midline defect that causes a series of genitourinary and muscular malformations, which demands surgical intervention for correction. Women with BE are fertile and able to have children without this disease. The purpose of this study is to assess the sexual function and quality of life of women treated for BE. MATERIALS AND METHODS All patients in our institution treated for BE from 1987 to 2007 were recruited to answer a questionnaire about their quality of life and pregnancies. RESULTS Fourteen women were submitted to surgical treatment for BE and had 22 pregnancies during the studied period. From those, 17 pregnancies (77.2%) resulted in healthy babies, while four patients (18.1%) had a spontaneous abortion due to genital prolapse, and there was one case (4.7%) of death due to a pneumopathy one week after delivery. There was also one case (5.8%) of premature birth without greater repercussions. During pregnancy, three patients (21.4%) had urinary tract infections and one patient (7.14%) presented urinary retention. After delivery, three patients (21.4%) presented temporary urinary incontinence; one patient (7.14%) had a vesicocutaneous fistula and seven patients (50%) had genital prolapsed. All patients confirmed to have achieved urinary continence, a regular sexual life and normal pregnancies. All patients got married and pregnant older than the general population. CONCLUSIONS BE is a severe condition that demands medical and family assistance. Nevertheless, it is possible for the bearers of this condition to have a satisfactory and productive lifestyle.
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Affiliation(s)
- Amilcar Martins Giron
- Urology Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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