SUFU20: PANEL: UROLOGIC ISSUES IN PREGNANCY
Urologic Issues in Pregnancy PanelPregnancy represents a distinct and exceptionally complex physiologic state with significant impact on a variety of urologic concerns.Considerations must be made for not only the anatomic and physiologic alterations in the mother which may manifest during pregnancy, but also for the vulnerability of the fetus. Urologic issues such as stones and hydronephrosis, urinary diversion, and urinary tract infections often require a multidisciplinary approach given the unique maternal-fetal environment.I. Urinary DiversionAlthough considerable debate exists regarding management of pregnant patients with a urinary diversion, this session is designed to introduce concepts and present treatment options for potential issues that can arise. Best practices regarding surgical interventions and common pharmaceutical treatments for pregnant patients with diversions will be presented.Information will be provided regarding the impact of pregnancy on the physiology of urinary diversion, particularly with regards to hydronephrosis and renal function, along with special emphasis on matters encountered with catheterizable channels. Risks and strategies for contending with lower urinary tract and ascending infections in the pregnant diversion patient will be discussed. Counseling regarding potential selection criteria for determination of the mode of delivery will additionally be illustrated.II. Urinary Tract InfectionsUrinary tract infections are the most common type of infection during pregnancy, affecting 10% of women. The usual offender is Escherichia coli, but recent rise of resistance are narrowing available and safe antibiotics for expectant mothers. UTI in pregnancy can lead to hospitalization due to worsening infectious presentation in the mother as well as preterm labor. Inaddition, potential complications to the offspring are low birthweight, long term infectious morbidity and risks of specific birth defects. Although the dogmatic recommendations are to always treat urinary tract infections and asymptomatic bacteriuria in pregnancy, risks of infections should be weighed against effects of antibiotics such as antimicrobial resistance and developmental risks to the fetus.III. Stones & HydronephrosisOverall risk of stones in pregnancy is similar to non-pregnant women. Additional risk factors (increased filtered loads of Ca, Na, and uric acid) are balanced by factors that decrease risk (forced diuresis, increased excretion of citrate, Mg, and glycoproteins). The usual evaluation of nephrolithiasis is complicated by physiologic changes in the urinary tract as 90% of pregnant women have hydronephrosis (right > left) and desire to avoid radiation to the fetus.Stones/HydronephrosisPanelist: Karen L. Stern, MDUrinary DiversionPanelist: Melissa R. Kaufman, MD, PhD, FACSUTIPanelist: Lysanne Campeau, MDCM, PhD, FRCSC