Urological problems in pregnancy

BJU International (2002), 89, 469±476

Urological problems in pregnancy C . C H A L I H A and S . L . S T A N T O N * East Surrey Hospital, Redhill, and *St George's Hospital, London, UK

During pregnancy the urinary tract undergoes extensive anatomical and physiological changes. These changes may be further in¯uenced by alteration in renal function and intercurrent pathology in pregnancy, and changes resulting from labour and delivery.

under the elevated levels of oestrogen but the increased levels of progesterone lead to a relative bladder hypotonia and increased bladder capacity. The bladder is drawn upwards anteriorly as the uterus enlarges, becoming more of an abdominal than a pelvic organ by the third trimester. The base of the bladder enlarges and the trigone becomes more convex than concave. Radiological studies in pregnancy show that the bladder is distorted by the fundus, and in labour the bladder neck is displaced forwards and becomes more funnelled [2]. Iosif et al. [3] performed urethral pressure pro®lometry and simultaneous urethrocystometry in 14 healthy continent primiparae in the ®rst and late third trimester, and again 5±7 days postpartum, and reported an increase in total and functional urethral length, with an increase in intravesical pressure from 9 to 20 cmH2O, and a corresponding increase in urethral closure pressure.

Anatomical and physiological changes

Problems in pregnancy

The upper urinary tract

The upper urinary tract

In normal pregnancy the kidneys elongate by 105 c.f.u./mL of urine; however, counts as low as 102 may represent active infection in pregnancy [4]. The prevalence of asymptomatic bacteriuria is similar to that in a nonpregnant population, at 5±10%, but there is a 3± 4-fold higher progression rate, with