937 Investigation and Management of Symptomatic Hydronephrosis in Pregnancy, a Retrospective Study

Abstract

Abstract Aim Although hydronephrosis in pregnancy can be a common physiological phenomenon, if symptomatic, it may represent a pathological process requiring further investigation and management. The purpose of the study was to determine how symptomatic hydronephrosis in pregnancy presents, and the proportion of cases requiring further investigation and management. Method A retrospective study was carried out at a District General Hospital. A search was conducted on PACS for all ultrasound abdomen/kidneys/urinary tract performed between August 2019 and August 2022, where requests/reports had the terms ‘pregnant’, ‘pregnancy’ or ‘gestation’. Results Of the 261 ultrasound scans performed, 39 had reported hydronephrosis (mean age 28.6, range 19-39; laterality: 22 right, 6 left, 11 bilateral), of which 31 were symptomatic of pain, dysuria and/or pyrexia. Seven patients warranted further acute imaging (4 MRI, 2 low-dose CTKUB, 1 had both following inconclusive MRI). A majority of patients (33/39, 92%) with hydronephrosis were conservatively managed and had resolution of symptoms. Only 3 patients (8%) required eventual emergency management – two had nephrostomy insertion (without any further imaging other than ultrasound) and one had retrograde stenting (after management was planned using CT). Conclusions A majority of women with symptomatic hydronephrosis in pregnancy are successfully managed conservatively and will rarely require further investigation with radiation. Limited radiation may be indicated where this will impact upon treatment. There is need for a consensus to guide management of these patients, weighing up risks vs benefits of further investigation and intervention.