A prospective study of urological problems in pregnancy

Author: 
Govindarajan.R., Matheen Jaffer Farman.R and Rajeev Ayyappan R

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 2014 to February 2016. 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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