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Bey E, Perrouin-Verbe B, Reiss B, Lefort M, Le Normand L, Perrouin-Verbe MA. Outcomes of pregnancy and delivery in women with continent lower urinary tract reconstruction: systematic review of the literature. Int Urogynecol J 2021; 32:1707-1717. [PMID: 34125241 DOI: 10.1007/s00192-021-04856-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/09/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this systematic review of the literature was to pool all the existing data regarding pregnancy and delivery in women with neurogenic bladder or bladder exstrophy who had undergone previous lower urinary tract reconstruction (LUTR). METHODS We conducted a systematic review of the literature from PubMed/MedLine, ClinicalTrials.gov and the Google Scholar database, from 1972 to July 2020. Fifty articles were included, of which 25 contained data that could be pooled (229 women representing 292 pregnancies). RESULTS Ninety-eight women had bladder exstrophy (43%), 58 had spinal dysraphism (25%), 14 had spinal cord injury (6%), and 59 presented other pathological conditions. Of these, 138 have had an augmentation cystoplasty (61%), 42 (18%) had a continent cutaneous urinary diversion, and 31 had an artificial urinary sphincter (14%). During their pregnancy, 97 women (33%) experienced at least one febrile urinary tract infection. Thirty-one women (11%) required ureteral stenting or nephrostomy placement for upper urinary tract dilatation. Forty-six pregnancies ended with premature delivery (16%). Delivery mode was by C-section for 108 patients (62%) and vaginal delivery for 104 (36%). Twenty complications were reported during delivery (mainly urological), of which 19 occurred during C-section. Nine women experienced postpartum urinary incontinence (4%); in 5 of then this was due to urinary fistulae secondary to complicated C-section. CONCLUSIONS Pregnancy and vaginal delivery are possible for women with LUTR who have no obstetric or medical contraindications, except for some particular cases of bladder exstrophy. However, these high-risk pregnancies and deliveries should be managed by a specialist multidisciplinary team.
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Affiliation(s)
- Elsa Bey
- Department of Urology, CHU-Université de Nantes, 1 place Alexis Ricordeau, 44000, Nantes, France.
| | - Brigitte Perrouin-Verbe
- Physical Medicine and Rehabilitation Department, CHU-Université de Nantes, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - Bénédicte Reiss
- Physical Medicine and Rehabilitation Department, CHU-Université de Nantes, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - Marc Lefort
- Physical Medicine and Rehabilitation Department, CHU-Université de Nantes, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - Loïc Le Normand
- Department of Urology, CHU-Université de Nantes, 1 place Alexis Ricordeau, 44000, Nantes, France
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Tanacan A, Aktoz F, Fadiloglu E, Unal C, Beksac MS. A pregnant woman with an operated bladder extrophy and a pregnancy complicated by placenta previa and preterm labor. CASE REPORTS IN PERINATAL MEDICINE 2018. [DOI: 10.1515/crpm-2018-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Bladder exstrophy (BE) is a complex congenital anomaly that affects the urinary, reproductive, musculoskeletal and intestinal systems.
Highlights
This pregnancy case was complicated by BE, methylenetetrahydrofolate reductase (MTHFR) A1298C and plasminogen Activator inhibitör-1 (PAI) 4G/4G homozygous polymorphisms, placenta previa, preterm labor and preterm premature rupture of the membranes. The fetus was evaluated by ultrasonography daily and anhydramnios was detected on the 2nd day of the patient’s hospitalization. A cesarean section (C/S) was performed at 27 weeks and 6 days of gestation and a 1330 g male infant was delivered.
Conclusions
Adult female patients with BE can have successful pregnancy outcomes if they receive appropriate antenatal care. However, the follow-up of these patients must be carried out at experienced tertiary reference centers with a multidisciplinary approach. This difficult process must be managed by obstetricians, neonatologists, urologists and pediatric surgeons working together.
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Hanprasertpong T, Wootipoom V, Tanthanuch M, Hanprasertpong J. Successful pregnancy in a non-reconstructed congenital bladder extrosphy woman: the first case report. Arch Gynecol Obstet 2013; 288:955-7. [PMID: 23525629 DOI: 10.1007/s00404-013-2790-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 03/05/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Tharangrut Hanprasertpong
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand,
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Deans R, Banks F, Liao LM, Wood D, Woodhouse C, Creighton SM. Reproductive outcomes in women with classic bladder exstrophy: an observational cross-sectional study. Am J Obstet Gynecol 2012; 206:496.e1-6. [PMID: 22537419 DOI: 10.1016/j.ajog.2012.03.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 03/05/2012] [Accepted: 03/21/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE We sought to examine the reproductive outcomes of 52 women with classical bladder exstrophy. STUDY DESIGN This was an observational study with cross-sectional and retrospective arms. RESULTS The average age of the sample was 33 years (range, 17-63). Of those who had tried, 19/38 (66%) had conceived. A total of 57 pregnancies (3 sets of twins) were reported for the 19 patients and resulted in 34/57 live births (56%), 21/57 miscarriages (35%), 1/57 (2%) termination, and 4/57 (7%) stillbirths or neonatal deaths. Four deliveries resulted in major complications including 1 transection of the ureter (4%), 1 fistula formation (4%), and 2 postpartum hemorrhages (8%). There were 2 admissions to intensive care, one for urinary sepsis and another for massive obstetric hemorrhage. CONCLUSION Fertility is impaired in women with bladder exstrophy. Pregnancy is high risk both for the mother and baby. Delivery should be at a tertiary referral obstetric unit with urology cover. In the majority of cases planned cesarean section is the most appropriate mode of delivery.
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Bildircin FD, Ayyildiz HS, Tosun M, Malatyalioglu E, Ariturk E, Sakinci M. Successful pregnancy and delivery in a patient with bladder exstrophy. J Pediatr Adolesc Gynecol 2012; 25:e69-71. [PMID: 22578486 DOI: 10.1016/j.jpag.2012.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Revised: 12/27/2011] [Accepted: 02/01/2012] [Indexed: 11/15/2022]
Abstract
Bladder exstrophy (BE) is a rare congenital anomaly. Owing to the advanced reconstructive surgical techniques and effective antibiotics, the incidence of urinary and systemic complications in patients with BE has decreased and the life expectancy has increased. However, this brings along social, sexual, and psychological problems; particularly, successful pregnancy and delivery is extremely rare in females with BE. We present a pregnancy of an 18-year-old female with BE, who has been followed at our university hospital since birth.
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Affiliation(s)
- Fatma Devran Bildircin
- Department of Gynecology and Obstetrics, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
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Ansari MS, Gearhart JP, Cervellione RM, Sponseller PD. The application of pelvic osteotomy in adult female patients with exstrophy: applications and outcomes. BJU Int 2011; 108:908-12. [PMID: 21314813 DOI: 10.1111/j.1464-410x.2010.10018.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE • To apply the technique of pelvic osteotomy to a select group of adult female patients with exstrophy, in view of the low complication rate and acceptable success rate of the technique. PATIENTS AND METHODS • We applied this technique as an adjunct to uterovaginal suspension and abdominal wall repair after our prior success in treating patients with extreme pelvic diastasis. • Bilateral innominate (transverse) and vertical iliac osteotomies were done from an anterior approach and an external fixator was placed. The fixator and pelvic bones were gradually cranked together over a period of 2-3 weeks until the diastasis was less than 4 cm. • Then sacrocolpopexy was performed with revision of the abdominal wall and revision genitoplasty along with the placement of an intrasymphyseal titanium plate. RESULTS • Six patients presented with uterine/vaginal prolapse and concerns about the appearance of their abdominal wall and genitalia. Three patients had undergone uterine suspension before and one patient had had five prior attempts at suspension, which failed. The mean (range) age was 22.3 (18-26) years. • All the patients underwent staged reduction of pubic diastasis and sacrocolpopexy along with revision of the abdominal wall and in four cases revision genitoplasty was also performed. The mean (range) diastasis was 12.8 (8-18) cm and 2.8 (3-4) cm before and after staged reduction respectively. • Complications included transient femoral nerve palsy (two) and foot drop secondary to sciatic nerve stretch (one), which resolved with time. The symphyseal plate needed to be removed in three patients: secondary to persistent pain at the site (one), persistent discharge from the lower abdominal wound (one) and erosion into the anterior wall of the vagina (one). • At a mean (range) follow-up of 60.7 (2-137) months the cosmetic and functional outcome of the abdominal wall reconstruction and genitoplasty was good with all the patients being satisfied. Five patients are currently sexually active and none has had a recurrence of their prolapse. None has become pregnant yet. CONCLUSIONS • Although the morbidity of this procedure in the adult is not insignificant, it is a valuable adjunct to pelvic floor reconstruction in young women of childbearing age even in those who have had prior suspension procedures. • In addition, it allows the movement of lateral previously unoperated skin into the midline, allowing scar and skin replacement with healthier more vascularized tissue.
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Affiliation(s)
- Mohd S Ansari
- Sanjay Gandhi Postgraduate Institute of Medical Sciences - Urology and Renal Transplantation, Lucknow, India.
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Castagnetti M, Berrettini A, Zhapa E, Rigamonti W, Zattoni F. Issues with the external and internal genitalia in postpubertal females born with classic bladder exstrophy: a surgical series. J Pediatr Adolesc Gynecol 2011; 24:48-52. [PMID: 20869278 DOI: 10.1016/j.jpag.2010.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 05/31/2010] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To report our experience with surgical management of gynecological issues in postpubertal female patients born with classic bladder exstrophy (BE). DESIGN Retrospective review of clinical charts. SETTING Tertiary pediatric urology unit. PARTICIPANTS 16 postpubertal female BE patients. INTERVENTIONS Cosmetic surgery to the external genitalia, widening of vaginal introitus, and treatment of pelvic organ prolapse. MAIN OUTCOME MEASURES patient satisfaction and additional gynecological problems during follow-up. RESULTS Eight cases (14-43 years old) underwent cosmetic procedures. All resulted in improved cosmesis, but one case complained of reduced erogenous sensitivity after clitoridoplasty. Five cases (17-20 years old) underwent widening of the vaginal introitus. The modification was as short as possible to avoid any foreshortening of the dorsal vaginal wall. Three cases 33-45 years old presented with pelvic organ prolapse. All were sexually active. One had already given birth. All the three had previously been submitted elsewhere to a posterior vaginal cutback and one to hysterectomy. Two are still awaiting further treatment due to recurrent prolapse. CONCLUSION Female BE patients can seek advice to improve the appearance of the external genitalia at any ages. Clitoridoplasty should be considered carefully, because it may harm erogenous sensitivity. Problems with the vaginal introitus typically present at around 20 years of age, probably when BE patients become sexually active. Opening too widely the introitus can cause a foreshortening of the posterior vaginal wall, predisposing to pelvic organ prolapse. Treatment of pelvic organ prolapse is difficult.
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Affiliation(s)
- Marco Castagnetti
- Section of Paediatric Urology, Department of Oncological and Surgical Sciences, University Hospital of Padova, Padua, Italy.
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Hensle TW, Bingham JB, Reiley EA, Cleary-Goldman JE, Malone FD, Robinson JN. The urological care and outcome of pregnancy after urinary tract reconstruction. BJU Int 2004; 93:588-90. [PMID: 15008736 DOI: 10.1111/j.1464-410x.2003.04665.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess the obstetric and urological outcomes during and after pregnancy following urinary tract reconstruction, as pregnancies after such surgery can have a significant effect on the function of the reconstructed urinary tract, and the reconstruction can significantly affect the delivery of the fetus. PATIENTS AND METHODS We retrospectively reviewed the obstetric and urological history of 11 patients (12 pregnancies; 10 singletons and one twin) with previous urinary reconstruction, delivered between 1989 and 2003. Antepartum and postpartum urological function and obstetric outcomes were investigated. RESULTS All the patients had some difficulty with clean intermittent catheterization (CIC) during pregnancy, and four needed continuous indwelling catheters. During pregnancy 10 women had several bladder infections and all received antibiotic suppression. There were eight Caesarean sections, two vaginal deliveries and one combined delivery. Six Caesareans were elective and three were emergent. The use of CIC returned to normal in all patients after delivery. CONCLUSIONS Women with a urinary reconstruction can have successful pregnancies. The complexity of the surgery and the concern for possible emergency Caesarean section resulted in most patients having an elective Caesarean delivery before term. Antibiotic prophylaxis is recommended and patients may require indwelling dwelling catheters while pregnant but normal CIC can be resumed after delivery.
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Affiliation(s)
- T W Hensle
- Division of Paediatric Urology, Children's Hospital of New York, Presbyterian, NY, USA.
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Ghanem M, Yoshida C, Isobe N, Nakao T, Yamashiro H, Kubota H, Miyake YI, Nakada K. Atresia ani with diphallus and separate scrota in a calf: a case report. Theriogenology 2004; 61:1205-13. [PMID: 15036955 DOI: 10.1016/j.theriogenology.2003.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2002] [Accepted: 04/28/2003] [Indexed: 10/26/2022]
Abstract
Atresia ani, a common genetic defect in animals, is often accompanied by urogenital defects in calves. This paper reports a case of atresia ani with diphallus and separate scrota in a calf. The calf was born with atresia ani; surgery (to open the anus) was performed 3 days after birth. No urogenital abnormalities were noticed until 4 months after birth. At that time, two separate scrota (each containing a testis) and a sac-like structure in the middle of two scrota, were visible. The gait was abnormal, with abduction of the hind limbs while walking. Additionally, the hind legs appeared wider than usual at the hip joints. Two weeks later, two peni (diphallia) was observed, each in a separate preputial sheath. The calf had a normal karyotype on cytogenetic examination. Plasma concentrations of testosterone at 5.5, 6, and 7 months of age were 3.5, 1.9, and 1.7 ng/ml, respectively. At necropsy (7 months of age), the prepuce was thick and the glans of the right penis was adhered to the prepuce. The left penis did not have a urethra or retractor penis muscles. The sac-like structure in the middle of the two scrota contained the urinary bladder and a loop of small intestine. The pubic bone had failed to fuse at the pelvic symphysis. In conclusion, this is the first reported case of atresia ani with diphallus, separate scrota, and pubic bone separation in a calf.
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Affiliation(s)
- Mohamed Ghanem
- Laboratory of Animal Science, Graduate School for International Development and Cooperation, Hiroshima University, 1-5-1 Kagamiyama, Higashi-Hiroshima 739-8529, Japan
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