Management of pregnancy after augmentation cystoplasty

We contacted 256 members of the Society for Pediatric Urology to determine their experience with patients who had undergone augmentation cystoplasty and who later became pregnant and delivered a baby. There were 15 pregnancies in 15 patients. Urinary tract infection or pyelonephritis complicated 9 of the 15 pregnancies (60%) and 4 patients experienced premature labor. Serum creatinine levels remained stable throughout pregnancy in 14 patients. Delivery was vaginal in 10 patients, each of whom had the native continence mechanism intact, and by cesarean section in 5, of whom 3 had had prior surgical reconstruction of the vesical neck. There were no intraoperative or postoperative complications. As a consequence of this study, we recommend that patients who have had an enterocystoplasty alone should not be at an increased risk for incontinence from a vaginal delivery. Conversely, patients who have undergone augmentation cystoplasty and either vesical neck reconstruction or placement of an artificial genitourinary sphincter to attain continence should undergo cesarean section delivery to avoid the potential for disruption of the continence mechanism.