title: Management of ureteral stenting for postrenal failure during pregnancy after ureteral reimplantation: a case report.
abstract: BACKGROUND
  Vesicoureteral reflux is thought to predispose to urinary tract infection and renal scarring, and ureteral reimplantation in childhood remains the gold standard for its treatment. It has been reported that the risk of postrenal failure during pregnancy is increased among women with Politano-Leadbetter ureteral reimplantation. In previous case reports on patients with progressive hydronephrosis and renal failure during pregnancy after ureteral reimplantation, percutaneous nephrostomy was always required, so there has been no information about the clinical management of such patients by ureteral stenting. Here we report a patient with a history of bilateral ureteral reimplantation, in whom severe hydronephrosis during pregnancy was managed with ureteral stents.
  
  
  METHODS
  A primigravida with severe hydronephrosis was referred to us at 29 weeks of gestation. Bilateral Politano-Leadbetter ureteral reimplantation had been performed at the age of 3 years. She was hospitalized immediately, and bilateral ureteral stents were successfully inserted. Post-obstructive diuresis occurred after the stents were placed. Urinary tract infection developed after removal of the urethral catheter 1 week later, but responded to antibiotic therapy and catheter replacement. Labor was induced at 39 weeks of gestation, with vaginal delivery of a healthy male infant. Both stents were found to have spontaneously migrated into the urethra after delivery. Repeat stenting under spinal anesthesia was required to improve postpartum symptoms of back pain and fever. Right distal ureteral obstruction persisted at 6 months after delivery and repeat ureteral reimplantation is planned.
  
  
  CONCLUSIONS
  General obstetricians will not necessarily pay attention to a history of Politano-Leadbetter ureteral reimplantation, but these patients should undergo careful monitoring of renal function and urinary tract morphology during perinatal care. In the present case, ureteral stenting was effective for postrenal failure during pregnancy after ureteral reimplantation. If ureteral stenting is selected, attention should be paid to post-obstructive diuresis, infection, and stent migration.
authors.affiliation: Department of Obstetrics and Gynecology, National Hospital Organization Higashi-Ohmi General Medical Center, 255 Gochi-cho, Higashiohmi, Shiga, 527-0044, Japan. yone611228@gmail.com.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yoneoka
authors.affiliation: Department of Obstetrics and Gynecology, National Hospital Organization Higashi-Ohmi General Medical Center, 255 Gochi-cho, Higashiohmi, Shiga, 527-0044, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Kaku
authors.affiliation: Department of Obstetrics and Gynecology, Shiga University of Medical Science, Seta tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
authors.forename: Shunichiro
authors.initials: S
authors.lastname: Tsuji
authors.affiliation: Department of Urology, Kohka Public Hospital, 1256 Minakuchichomatsuo, kohka, Shiga, 528-0074, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Yamashita
authors.affiliation: Department of Obstetrics and Gynecology, National Hospital Organization Higashi-Ohmi General Medical Center, 255 Gochi-cho, Higashiohmi, Shiga, 527-0044, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Department of Obstetrics and Gynecology, Shiga University of Medical Science, Seta tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
authors.forename: Fuminori
authors.initials: F
authors.lastname: Kimura
authors.affiliation: Department of Obstetrics and Gynecology, Shiga University of Medical Science, Seta tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Murakami
mesh_terms: D005260:Female; D005548:Foreign-Body Migration / Q000150:complications; D006801:Humans; D006869:Hydronephrosis / Q000601:surgery; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology / Q000601:surgery*; D051437:Renal Insufficiency / Q000209:etiology / Q000601:surgery*; D012092:Replantation / Q000009:adverse effects*; D015607:Stents; D014513:Ureter / Q000601:surgery*; D055815:Young Adult
keywords: Postrenal failure; Pregnancy; Ureteral reimplantation; Ureteral stenting