Symptomatic physiologic hydronephrosis in pregnancy - Incidence, complications and treatment

Objective: We present the incidence and results of treatment of symptomatic physiologic hydronephrosis in 3,400 pregnant women. Methods: We analyzed 103 consecutive women who presented with clinical sign s and symptoms related to the upper urinary system. Renal sonography, urina lysis, serum creatinine levels, white blood cell (WBC) count, and urine cul ture were done in all patients at first visit and repeated at least once a month until 1 month after delivery. In patients who manifested acute pyelon ephritis, urinalysis, WBC count, erythrocyte sedimentation rate and C-react ive protein levels were repeated every 3 days until normalization, and urin e culture as well as renal sonography were performed once a week until 1 mo nth after delivery. Conservative measures (positioning, analgesia, antibiot ics) were performed in all patients with symptomatic physiologic hydronephr osis. If the patient's condition was refractory to medical management, drai nage of the ureter with a double pigtail stent was performed. Results: Conservative measures were successful in 97 (94%) of 103 patients but 6 (6%) patients had ongoing signs and symptoms of acute pyelonephritis progressing to urosepsis. In all of them, antibiotics were continued and a double pigtail stent was placed resulting in fast regression of symptoms, c uring of renal infection and progresse of the pregnancies to the term with vaginal delivery. Conclusions: Symptomatic hydronephrosis in pregnancy can be treated conserv atively. If the patient's condition is refractory to medical management, an internal drainage with double pigtail stent may be necessary. Copyright (C ) 2001 S. Karger AG, Basel.