Abstract
BackgroundVesicoureteral reflux is thought to predispose to urinary tract infection and renal scarring, and ureteral reimplantation in childhood remains the gold standard for its treatment. It has been reported that the risk of postrenal failure during pregnancy is increased among women with Politano-Leadbetter ureteral reimplantation. In previous case reports on patients with progressive hydronephrosis and renal failure during pregnancy after ureteral reimplantation, percutaneous nephrostomy was always required, so there has been no information about the clinical management of such patients by ureteral stenting. Here we report a patient with a history of bilateral ureteral reimplantation, in whom severe hydronephrosis during pregnancy was managed with ureteral stents.Case presentationA primigravida with severe hydronephrosis was referred to us at 29 weeks of gestation. Bilateral Politano-Leadbetter ureteral reimplantation had been performed at the age of 3 years. She was hospitalized immediately, and bilateral ureteral stents were successfully inserted. Post-obstructive diuresis occurred after the stents were placed. Urinary tract infection developed after removal of the urethral catheter 1 week later, but responded to antibiotic therapy and catheter replacement. Labor was induced at 39 weeks of gestation, with vaginal delivery of a healthy male infant. Both stents were found to have spontaneously migrated into the urethra after delivery. Repeat stenting under spinal anesthesia was required to improve postpartum symptoms of back pain and fever. Right distal ureteral obstruction persisted at 6 months after delivery and repeat ureteral reimplantation is planned.ConclusionsGeneral obstetricians will not necessarily pay attention to a history of Politano-Leadbetter ureteral reimplantation, but these patients should undergo careful monitoring of renal function and urinary tract morphology during perinatal care. In the present case, ureteral stenting was effective for postrenal failure during pregnancy after ureteral reimplantation. If ureteral stenting is selected, attention should be paid to post-obstructive diuresis, infection, and stent migration.
Highlights
Vesicoureteral reflux is thought to predispose to urinary tract infection and renal scarring, and ureteral reimplantation in childhood remains the gold standard for its treatment
Ureteral stenting was effective for postrenal failure during pregnancy after ureteral reimplantation
If ureteral stenting is selected, attention should be paid to post-obstructive diuresis, infection, and stent migration
Summary
A search of the English literature in PubMed using key words including “vesicoureteral reflux”, “ureteral reimplantation”, and “pregnancy” identified seven women with postrenal failure during pregnancy after undergoing ureteral reimplantation in childhood. Our patient developed symptoms of urinary tract infection accompanied by a strong inflammatory response and positive urine culture soon after the removal of the urethral catheter at 1 week after ureteral stent placement. Their second patient received repeat ureteral reimplantation by the Cohen method 3 years before her pregnancy, but she still required bilateral nephrostomy due to hydronephrosis, hypertension, and azotemia at 29 weeks of gestation Their third patient had repeat reimplantation and subsequently experienced two uneventful pregnancies without urological complications. In their fourth case, recurrent renal infection was a problem during the first pregnancy and right percutaneous nephrostomy was performed during the second pregnancy, but conservative treatment was sufficient for the third pregnancy [1]. All authors approved the final version and agreed to be accountable for all aspects
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