Document Detail


Urinary tract infections and pregnancy in women who underwent antireflux surgery in childhood.
MedLine Citation:
PMID:  9507854     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: For several decades ureteroneocystostomy has been performed in children to correct primary vesicoureteral reflux. A purported indication for antireflux surgery is to prevent significant upper urinary tract infection during pregnancy. We performed a long-term followup of women who underwent antireflux surgery during childhood to determine outcome in regard to urinary tract infection history and pregnancy. MATERIALS AND METHODS: We identified 227 women of childbearing age who underwent ureteral reimplantation for primary vesicoureteral reflux from 1964 through 1981. Of the 122 women contacted 41 had been pregnant (77 total pregnancies). Cystitis or asymptomatic bacteriuria and pyelonephritis developed during 18 and 5 pregnancies, respectively. The 77 pregnancies resulted in 57 term births, 7 voluntary pregnancy interruptions and 13 spontaneous abortions. RESULTS: Patients who previously underwent successful antireflux surgery continued to have a significant number of urinary tract infections through the intervening years. Despite a higher than expected incidence of pyelonephritis, they had relatively little hypertension and renal insufficiency. During pregnancy the incidence of pyelonephritis was only slightly higher than that of the general population. However, severe complications of pregnancy, such as preeclampsia, premature birth and acute renal failure, occurred more frequently in women with a history of renal scarring or hypertension (7 of 12) than in those with a history of recurrent infection alone (3 of 10). CONCLUSIONS: When renal scarring is present, reflux should be corrected before pregnancy to minimize maternal and fetal morbidity. When scarring is not present, the literature suggests that women with a history of reflux are at increased risk for pyelonephritis during pregnancy whether or not ureterocystostomy was performed. Pregnant women with a history of reflux may benefit from prophylactic antibiotics and women with reflux nephropathy should be followed throughout life.
Authors:
T P Bukowski; G G Betrus; J W Aquilina; A D Perlmutter
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of urology     Volume:  159     ISSN:  0022-5347     ISO Abbreviation:  J. Urol.     Publication Date:  1998 Apr 
Date Detail:
Created Date:  1998-04-09     Completed Date:  1998-04-09     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1286-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, USA.
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MeSH Terms
Descriptor/Qualifier:
Child
Child, Preschool
Cystitis / epidemiology*
Female
Fetal Diseases / epidemiology
Follow-Up Studies
Humans
Incidence
Infant
Pregnancy
Pregnancy Complications, Infectious / epidemiology*
Pyelonephritis / epidemiology*
Retrospective Studies
Time Factors
Treatment Outcome
Urinary Tract Infections / epidemiology*
Vesico-Ureteral Reflux / surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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