Late post-reimplantation ureteral obstruction during pregnancy: a transient phenomenon?

Patients with a history of surgical correction of vesicoureteral reflux warrant surveillance for long-term complications. However, there are little data on long-term outcome, based mainly on small series and insufficient followup. Close followup is particularly indicated during pregnancy since these patients tend to have a dilated collecting system and frequent urinary tract infections. As part of a long-term postoperative assessment of patients who underwent ureteral reimplantations in childhood, we focused on late pregnancy related obstructive dilatation associated with renal failure.

Between 1970 and 1979, 322 children underwent ureteral reimplantation at our institution. A comprehensive retrospective study done to evaluate the long-term postoperative outcome, detected 2 cases of late gestational ureteral obstruction. Subsequently 2 additional cases were identified elsewhere.

All 4 patients underwent successful Politano-Leadbetter ureteral reimplantation at ages 4 to 12 years. They presented during pregnancy 17 to 22 years postoperatively with progressive hydroureteronephrosis and renal failure, which required urinary drainage by percutaneous nephrostomies. Antegrade studies performed during pregnancy and in the early post-delivery period revealed severe obstruction of the distal ureters, which gradually subsided.

Ureteral obstruction during pregnancy, in women who previously underwent Politano-Leadbetter ureteral reimplantation, may be attributed to high reimplantation syndrome and is likely to be a transient phenomenon. Awareness of this late and rare complication may enable us to detect this situation early, provide temporary adequate urinary drainage and prevent unnecessary surgical procedures.