Comparative study of conservative and surgical management for symptomatic moderate and severe hydronephrosis in pregnancy: a prospective randomized study.
BACKGROUND
To analyze the role of different measures in the treatment of acute moderate or severe symptomatic hydronephrosis in pregnancy.


METHODS
Of the 18,130 women delivering at our institution between January 2000 and December 2004, 93 patients were admitted due to symptomatic hydronephrosis. Among these, 50 patients were diagnosed with moderate or severe hydronephrosis, and were randomly treated with conservative measures (25 patients) or double pigtail stent insertion (25 patients). Renal sonography, urinalysis, serum creatinine levels, white blood cell counts, and urine culture were done in all patients at first visit. The clinical and perinatal outcomes of the two groups were compared.


RESULTS
The incidence of symptomatic hydronephrosis in pregnancy was 0.5% in our institution (93/18,130). The majority of the moderate or severe hydronephrosis (88%) cases were diagnosed after the first trimester. There were no statistically significant differences in the fetal body weight, Apgar score, preterm labor, and hospitalization day between the two groups. Among those receiving conservative treatment, five patients (5/25, 20%) failed to respond and were subsequently treated by double pigtail stent insertion successfully, compared with the surgical group, in which all patients were successfully relieved by double pigtail stent (p=0.018). Four patients receiving double pigtail stent insertion complained of stent discomfort and flank pain after the procedure (16%).


CONCLUSIONS
Double pigtail stent insertion is effective for the treatment of moderate or severe symptomatic hydronephrosis in pregnancy, and showed a lower failure rate than the conservative treatment. However, due to the complications and discomfort with surgical treatment, conservative treatment should still be the first choice.
Tsai
Yieh-Loong
YL
Department of Obstetrics and Gynecology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Seow
Kok-Min
KM
Yieh
Chung-Hsin
CH
Chong
Kian-Mei
KM
Hwang
Jiann-Loung
JL
Lin
Yu-Hung
YH
Huang
Lee-Wen
LW
D000328:Adult; D001034:Apgar Score; D001806:Blood Urea Nitrogen; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D020567:Fetal Weight; D005865:Gestational Age; D006801:Humans; D006869:Hydronephrosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery* / Q000628:therapy*; D007902:Length of Stay; D007958:Leukocyte Count; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D010146:Pain / Q000209:etiology; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy*; D011446:Prospective Studies; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome; D014463:Ultrasonography
D002097:C-Reactive Protein