[Management of pregnancy and delivery after augmentation cystoplasty].

We report 2 cases of women who became pregnant and experienced vaginal delivery after augmentation cystoplasty. CASE 1: A 23-year-old woman with spina bifida became pregnant 3 years after augmentation sigmoidocystoplasty which had been performed to treat intractable urinary tract infection and urinary incontinence. During pregnancy, she developed febrile urinary tract infection twice which required antibiotics together with tight adherence to clean intermittent catheterization. At 36 weeks of gestation, she was safely delivered of a healthy baby. No deterioration of urinary continence level and renal function was observed after the delivery. CASE 2: A 32-year-old woman became pregnant 23 years after augmentation ileocecocystoplasty which had been performed to reconstruct diverted urinary tract due to a congenital hour-glass bladder. At 19 weeks of gestation, she developed acute pyelonephritis and hydronephrosis at right kidney which required antibiotics and indwelling urethral catheter. At 21 weeks of gestation, a drip infusion of ritodrine hydrochloride was started and maintained until 34 weeks of gestation to inhibit premature uterine contraction. At 29 weeks of gestation, she developed acute pyelonephritis and progressive hydronephrosis at left kidney, for which percutaneous nephrostomy drainage was deemed to be mandatory. She was delivered of a healthy baby at 36 weeks of gestation. Ten days after the delivery, both nephrostomy tube and indwelling urethral catheter were removed and clean intermittent catheterization was resumed. Total renal function was maintained during and after the pregnancy, and no deterioration of urinary continence was observed after the delivery. Since urinary tract infection is extremely common during pregnancy after augmentation cystoplasty, prevention and prompt intervention for urinary tract infection should be mandatory. Significant upper tract obstruction, if developed, should be treated by an effective urinary drainage. Thus, urological as well as obstetrical appropriate management is mandatory for the safe accomplishment of pregnancy and delivery after augmentation cystoplasty.