A Prospective Study of Urological Problems in Pregnancy

Abstract

Introduction: Pregnancy and delivery is a time of

major anatomical and physiological changes to the urinary

tract which may result in an alteration in urinary tract

function, most commonly manifested by the development

of urinary symptoms. Pregnant patients are typically

challenging to treat from a urological standpoint, as

pregnancy will often induce, exacerbate or complicate

urological complaints. Objective of this study is to analyze

various urological problems occuring in pregnancy and

the various modalities of their management with regard to

the special considerations for the gravid patient and

the alterations in the anatomy and physiology of the

genitourinary tract in pregnancy. Materials and Methods:

Antenatal patients in Govt. Kilpauk Medical College

Hospital and Govt. Royapettah Hospital with urological

problems from December 2015 to February 2017.

Antenatal patients have been evaluated for urological

problems based on symptoms, clinical findings, laboratory

and radiological investigations. Patients having evidence of

urological diseases were included in the study. The

incidence of urological problems and various modalities

and efficacy of treatment have been evaluated. Previously

diagnosed urological disease before pregnancy were

excluded. Antenatal patients referred to the urology out

patient department were evaluated for their urological

conditions. Results: The total number of antenatal cases

referred for urological problems in a 15 month period in

this study was 63 cases. The mean and median ages of

the patients were 24 years. The mean and median

gestational ages of the patients were 24 weeks. Majority

(57%) of the referrals were for incidental findings in

laboratory or imaging investigations. The most common

organism isolated in culture was E. coli irrespective of

primary diagnosis.

79% of calculus disease presented with symptoms

and 21% were asymptomatically detected calculi. Two cases

of PUJ obstruction presented with loin pain. One case of

pyelonephritis on right side presented with fever and right loin

tenderness. One case of clear cell renal cell carcinoma was

diagnosed with stage of pT2 N0 M0. No adverse obstetric

events were seen during this study. Conclusion: Pregnant

patients pose a unique clinical scenario to the urologist in

terms of specific presentations, diagnostic modalities and

management options. The goal of management should not

only include relief from the urological condition but also the

continued well being of the fetus and safe obstetric

management of the patient.