Pregnancy after augmentation cystoplasty

During the past ten years, many children with urinary diversions have undergone reconstruction of the urinary tract by means of augmentation cystoplasty, with or without an artificial genitourinary sphincter. We recently treated two patients with augmented bladders whose pregnancies were complicated by multiple infections of the urinary tract, urinary calculi and incontinence. One patient with an artificial genitourinary sphincter had malfunction of the device during the later stages of pregnancy; it resolved after birth. In the second patient, pyelonephritis may have led to premature delivery. Patients with these conditions must be observed for deterioration of renal function, obstruction of the urinary tract and infection throughout the pregnancy. In patients with augmentation and reconstruction of the vesical neck, we recommend delivery by cesarean section because of the potential for disruption of the continence mechanism.