Upper urinary tract complications in pregnant women with an ileal conduit. Lessons learned from two cases

We describe the occurrence of severe upper urinary tract complications during pregnancy in two women with an ileal conduit. The first patient developed several episodes of left pyelonephritis throughout the duration of her pregnancy but never received proper antibiotic prophylaxis. Intravenous urography performed after delivery documented bilateral staghorn kidney stones and a non-functioning left kidney. The second patient developed severe left loin pain and a high temperature during the fourth month of pregnancy after discontinuing antibiotic prophylaxis. An MRI urogram demonstrated compression of the ureter by the foetus. Symptoms were relieved as soon as the antibiotic prophylaxis was resumed and the pain remained under control with the occasional use of paracetamol until delivery. Based on these observations it appears that the left upper urinary tract may be more prone to dilatation in pregnant patients with an ileal conduit and antibiotic prophylaxis is mandatory throughout the duration of the pregnancy in order to minimize the risk of severe upper urinary tract complications.