Treatment of obstructive uropathy in pregnant women: the experience of a multidisciplinary Moscow hospital

Introduction. The lack of a clear algorithm of actions in pregnant women with obstructive uropathies often leads to a large number of unjustified drains that significantly reduce the quality of life of patients. The purpose of our study was to retrospectively evaluate the management of pregnant women in this group at different gestation periods. Materials and methods. A retrospective analysis of the results of treatment of290 pregnant women with obstructive uropathy was performed. The average age of patients was 27,4 years (min - 17, max - 40). The average gestation period is 21,4 weeks (min - 5, max - 35). All patients (n=290) according to the variants of obstructive uropathy were divided into 3 groups: group I - pregnant with a clinical picture of gestational pyelonephritis and the presence of retention of the upper urinary tract (n=162), group II - pregnant with the presence of retention of the upper urinary tract without signs of a systemic inflammatory reaction (n=86), group III - pregnant with diagnosed urolithiasis (n=42). Results. In all groups, conservative treatment was performed in 109 (37,6%) patients, operative treatment in the volume of internal ureteral stent placement was performed in 166 (57,2%) patients, in the volume of percutaneous puncture nephrostomy - in 4 (1,4%) patients, and operative treatment of urolithiasis for urgent indications - in 11 (3,8%) cases. The vast majority of pregnant women with diagnosed urolithiasis (n=34; 81,0%) were operated during gestation. The average bed-day of patients from all groups was 4.2 (min-1, max-15). All hospitalizations ended with discharge. Discussion. The results of the treatment of obstructive uropathy in pregnant women obtained in the course of the work are comparable with the available literature data. Early detection and treatment of urolithiasis during gestation is justified and leads to a decrease in the risks of complications during pregnancy and childbirth. The need to perform drainage operations for obstructive uropathy in pregnant women, according to our data, does not exceed 60%, in other cases, a positive effect is achievable with conservative therapy. If drainage is required, the latter should be short-term. Conclusion. Not every pregnant woman with retention of the upper urinary tract should be drained, and most patients do not need long-term drainage. In addition, surgical treatment of urolithiasis in pregnant women is effective and safe at any gestation period.