A Prospective Study of Urological Problems in Pregnancy
Abstract
Introduction: Pregnancy and delivery is a time of
major anatomical and physiological changes to the urinary
tract which may result in an alteration in urinary tract
function, most commonly manifested by the development
of urinary symptoms. Pregnant patients are typically
challenging to treat from a urological standpoint, as
pregnancy will often induce, exacerbate or complicate
urological complaints. Objective of this study is to analyze
various urological problems occuring in pregnancy and
the various modalities of their management with regard to
the special considerations for the gravid patient and
the alterations in the anatomy and physiology of the
genitourinary tract in pregnancy. Materials and Methods:
Antenatal patients in Govt. Kilpauk Medical College
Hospital and Govt. Royapettah Hospital with urological
problems from December 2015 to February 2017.
Antenatal patients have been evaluated for urological
problems based on symptoms, clinical findings, laboratory
and radiological investigations. Patients having evidence of
urological diseases were included in the study. The
incidence of urological problems and various modalities
and efficacy of treatment have been evaluated. Previously
diagnosed urological disease before pregnancy were
excluded. Antenatal patients referred to the urology out
patient department were evaluated for their urological
conditions. Results: The total number of antenatal cases
referred for urological problems in a 15 month period in
this study was 63 cases. The mean and median ages of
the patients were 24 years. The mean and median
gestational ages of the patients were 24 weeks. Majority
(57%) of the referrals were for incidental findings in
laboratory or imaging investigations. The most common
organism isolated in culture was E. coli irrespective of
primary diagnosis.
79% of calculus disease presented with symptoms
and 21% were asymptomatically detected calculi. Two cases
of PUJ obstruction presented with loin pain. One case of
pyelonephritis on right side presented with fever and right loin
tenderness. One case of clear cell renal cell carcinoma was
diagnosed with stage of pT2 N0 M0. No adverse obstetric
events were seen during this study. Conclusion: Pregnant
patients pose a unique clinical scenario to the urologist in
terms of specific presentations, diagnostic modalities and
management options. The goal of management should not
only include relief from the urological condition but also the
continued well being of the fetus and safe obstetric
management of the patient.
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