Pregnancy management in women within the bladder–exstrophy–epispadias complex (BEEC) after continent urinary diversion
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Management of operative delivery in pregnant women after reconstruction of the bladder–exstrophy–epispadias complex (BEEC) using bowel segments remains a challenge.
Patients and Methods
We report urological history, pregnancy and delivery course of two BEEC patients after previous abdominal bowel surgeries. One had an ileocecal pouch after previously failed reconstruction, and the other had an ileum augmentation and a catheterizable Mitrofanoff stoma after functional reconstruction of the exstrophic bladder.
Frequent bacteriuria and hydronephrosis warranted low-dose prophylaxis throughout pregnancy in one female, bilateral mild upper tract dilatation sonographic monitoring in both patients. Both were successfully delivered by cesarean section. No complications or clinical and sonographic signs for prolapse occurred. However, our operative experience revealed the importance of the abdominal incision type after different reconstructed reservoirs.
Though care should be intense in pregnant BEEC individuals, patients should not be discouraged to have own children. To facilitate successful pregnancy outcome operative delivery should be done as a interdisciplinary team work and emergency situations should be avoided by meticulous planning and counseling of the BEEC patients.
KeywordsPregnancy Urinary diversion Bladder augmentation Successful management Bladder–exstrophy–epispadias complex (BEEC)
Children’s Miracle Network Endowed Chair and grant CMNSB06. AKE, HR and WHR are members of the “Network for Systematic Investigation of the Molecular Causes, Clinical Implications and Psychosocial Outcome of Congenital Uro-Rectal Malformations (CURE-Net)” supported by a research grant from the German Federal Ministry of Education and Research (Deutsches Bundesministerium für Bildung und Forschung, BMBF).
Conflict of interest
All authors state no financial support and no conflict of interest.
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