Pregnancy in women with ureterosigmoidostomy

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.

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.

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.

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