Pregnancy in women with ureterosigmoidostomy.

Objectives: To review our experience with four pregnancies during the past 5 years with special attention to the diagnostic and therapeutic aspects of ureterosigmoidostomy. Pregnancy in women with ureterosigmoidostomy is a rare condition that differs in many ways from pregnancies in women with other forms of urinary diversion.

Methods: From 1995 to 2000, we observed four pregnancies in 3 women with ureterosigmoidostomy. Two women had had bladder exstrophy, and one had had interstitial cystitis. During pregnancy, we performed urologic examinations every 4 weeks with renal ultrasonography, calculation of the resistive index, and tests of serum electrolytes, urea, creatinine, and blood gas analysis. In all pregnancies, antibiotic prophylaxis was performed.

Results: All women had recurring urinary tract infections before pregnancy. In all cases, reversible dilation of the upper urinary tract was observed during pregnancy. The resistive index never increased to a pathologic range (greater than 0.7). With administration of sodium-potassium-hydrogen citrate, no acidosis was observed. With antibiotic prophylaxis, the women only had one episode each of urinary tract infection during pregnancy. One patient developed preeclampsia that led to a cesarean section at week 36 of gestation. Delivery was achieved by cesarean section in two more cases and vaginally in 1 case. We did not observe any postpartum or neonatal complications related to pregnancy.

Conclusions: Under regular urologic and gynecologic control, there is no contraindication to pregnancy in patients with ureterosigmoidostomy. Antibiotic prophylaxis seems to be recommended.