The authors discuss the course of pregnancies and the method of delivery in 10 women with an average age of 26 years in single fetus pregnancy who gave birth to a total of 13 healthy term babies (4 children of one mother, 2 children of two mothers, 1 child in the other women and two preterm babies of 27th and 29 th-week of pregnancy and 1 induction due to intrauterine death of a fetus in the 17th week of pregnancy). All pregnancies were the result of natural conception, and only one patient became pregnant after 8 years of regular intercourse. Perinatal and delivery care was provided in the period between 2008 - 2022 at the third reference degree hospital The reasons for reconstructive surgery in the children's hospital were 6 cases of myelomeningocele, 2 cases of spinal cord injury, 2 cases of tethered spinal cord, and 1 case of bladder exstrophy. In 7 patients with an average age of 16.6 years, continent or non continent conduit m. Mitrofanoff was performed and 6 patients underwent Malone or Malone antegrade colonic enema surgery for colon enemas. Two women performed clean intermittent catheterization (CIC) through the native urethra without prior LUTR. Five patients walk independently, and 5 were wheelchair dependent. All surgeries were performed at a children's hospital. Pregnancy in a woman after LUTR is burdened with a high risk of complications related to LUTR (difficulties in CIC and loss of the stomia, symptomatic urinary tract infections/urosepsis, obstruction in the outflow of urine from the upper urinary tract and hydronephrosis) and maternal-fetal complications (chorionamnionitis, PPROM, premature birth, delivery of a low birth weight baby, IUGR, preeclampsia).
All patients underwent CIC before and during pregnancy (100%), and one patient required a permanent indwelling catheter from the 21st week of pregnancy (10%. Another wheelchair dependent patient with myelomeningocele, despite following to a diet, had difficulties with the evacuation of bowel contents through the efficient catheterizable channel in the right-lower abdominal quadrant from the 30th week of pregnancy, which periodically required simultaneous infusions from the anus (10%). In the same patient, in the third week of postpartum, probably as a result of neglecting the regularity of CIC, tissue bridges were formed inside the vesicostomy, making CIC difficult and requiring indwelling Foley catheter for 12 weeks (10%). Regularity of CIC and bowel cleaning during pregnancy promotes the proper functioning of channels, which becomes particularly important in advanced pregnancy when the need to perform these activities more frequently due to the pressure of the enlarged uterus increases. At the same time, the enlarging uterus makes it difficult to visualize the opening of the stoma and requires assistance with a mirror, and the drainage of urine through the native urethra requires help from relatives (20%)
Continuous prevention of urinary tract infection (UTI) was not used in any pregnant woman. At the beginning of pregnancy, urine culture was performed to assess basic pyuria, and isolate the colonizing microbe and determine its sensitivity to antibiotics. Later in the pregnancy, urine culture and initiation of antibiotic therapy were determined by the increase in leukocyturia in serial urinalysis every 2-3 weeks and/or the developing symptomatic UTI. Symptomatic UTI caused by Klebsiella spp, Pseudomonas aeruginosa, E. coli or Klebsiella pneumoniae occurred in 5 women (50%) between 19 and 35 weeks of pregnancy, including 4 of them with urinary tract infections occurring twice during pregnancy. Patients with symptomatic UTIs were admitted to hospital for treatment. There was no urosepsis and no nephrostomy was placed. None of the women needed medications that affect bladder contractility. Three pregnancies were complicated by: cholecystectomy in 18th week of pregnancy, deep vein thrombosis of left leg in 28 week of 4th pregnancy and treatment due to active toxoplasmosis. All pregnancies ended with uncomplicated planned cesarean section with a catheter inserted into the channels (photo no.1). Undoubtedly, such a cesarean section requires careful preparation to protect the stoma for the later life. Apart from small adhesions in the peritoneum rotating the pregnant uterus towards the side of the stoma, no deterioration of the condition and function of the channels or an increase in the frequency of symptomatic UTI in the periods between pregnancies was observed in all but one patient.