Urological problems in pregnancy

Abstract

Abstract Important physiological changes to the urinary tract during pregnancy are examined, including physiological hydronephrosis of pregnancy and reduction in creatinine levels due to glomerular hyperfiltration. Changes in the anatomy contribute to an increased risk of urinary incontinence and lower urinary tract symptoms. Consequent urinary stasis contributes to a higher risk of urinary tract infection and pyelonephritis, which can contribute to preterm birth, and hence the importance of treating asymptomatic bacteriuria in the pregnant woman. Special attention may be given to the use of antibiotics in the different trimesters of pregnancy, and this is summarized in the chapter. The common diagnostic dilemmas of loin pain and hydronephrosis in pregnancy are debated, and guidance given on evaluation. Other essential urological issues that arise in pregnancy are reviewed, including the management of pregnant patients with previous urinary tract reconstruction, placenta accreta, and the problem of urinary retention after childbirth.