Pregnancy and Delivery in Women with Lower Urinary Tract Reconstruction: A National Multicenter Retrospective Study: From the French-Speaking Neuro-Urology Study Group (GENULF) and the Neuro-Urology Committee of the French Association of Urology

PURPOSE Management of pregnancy and delivery in women with lower urinary tract reconstruction is challenging and the currently available literature is insufficient to guide clinical practice. The purpose of this study was to report pregnancy and delivery outcomes in this specific population. MATERIALS AND METHODS A national multicenter retrospective study (16 centers) including 68 women with 96 deliveries between 1998 and 2019 was conducted. These women had at least one successful pregnancy and delivery after augmentation enterocystoplasty, catheterizable channel creation and/or artificial urinary sphincter implantation. Maternal and fetal complications during pregnancy and delivery were reported, as well as post-partum functional outcomes, according to the delivery mode. Chi-square test and Student's t-test were used to compare categorical and continuous variables, respectively. RESULTS Thirty-two percent of reported pregnancies were complicated by febrile urinary tract infections, 13.5% by renal colic and 14.6% required upper urinary tract diversion. Ten percent of patients reported transient self-catheterization difficulties, and 13.5% reported de novo or increased urinary incontinence. The preterm delivery rate was 35.3%. Elective C-section was performed in 61% of pregnancies. Twenty complications occurred during delivery (20%), including 19 during elective C-section. Urinary continence at 1 year was unchanged for 93.5% of deliveries. Delivery mode (p=0.293) and multiparity (p=0.572) had no impact on urinary continence. CONCLUSIONS In this population, C-section appeared to be associated with a high risk of complications. In the absence of any obstetric or neurologic contraindications, vaginal delivery should be proposed as first-line option to the majority of these women.