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Pregnancy After Lower Urinary Tract Reconstruction: Considerations for Prenatal Management and Delivery

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Abstract

Purpose of review

The goal of this work is to review the existing evidence base regarding the prenatal and delivery care for pregnant patients with a history of lower urinary tract reconstruction (LUTR). The primary audience of this work is both urologists and obstetricians who will be involved in the management of patients with LUTR.

Recent findings

The literature surrounding this topic is limited due to the small patient population. However, given significant advancements in care for patients with spinal dysraphism and complex urogenital anatomy these patients are living longer and are having richer social lives with relationships and childrearing. A systematic review published in 2020 found that vaginal delivery is possible for this patient population, with the exception of bladder exstrophy due to the risk of severe prolapse. Cesarean section in this population is associated with high complication rates and should be approached by a multidisciplinary team that includes a urologist who specializes in complex reconstructions. Increased surveillance for urinary tract infection/asymptomatic bacteriuria and upper tract deterioration should be performed.

Summary

Female patients with prior LUTR can safely become pregnant and carry to term. However, these patients represent a high-risk pregnancy group and require individualized multidisciplinary care to optimize their prenatal and delivery care. The choice of delivery modality should ultimately depend on anatomic and obstetric considerations, with a heavy emphasis on shared decision-making with the patient.

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Authors and Affiliations

  1. Department of Urology, University of Kansas Medical Center, Kansas City, USA

    Lauren N. Kennedy

  2. Department of Urology, Cedars-Sinai Medical Center, Los Angeles, USA

    Andrew L. Freedman

  3. Department of Urology, University of Kansas Medical Center, 400 Cambridge, Mailstop 3016, Kansas City, KS, 66160, USA

    Colby P. Souders

Authors
  1. Lauren N. Kennedy
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  2. Andrew L. Freedman
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  3. Colby P. Souders
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Correspondence to Colby P. Souders.

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Kennedy, L.N., Freedman, A.L. & Souders, C.P. Pregnancy After Lower Urinary Tract Reconstruction: Considerations for Prenatal Management and Delivery. Curr Bladder Dysfunct Rep 18, 310–317 (2023). https://doi.org/10.1007/s11884-023-00724-4

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  • DOI: https://doi.org/10.1007/s11884-023-00724-4

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