Sarcina și ureterohidronefroza. Avem sau nu motive să ne speriem

Introduction. One of the most frequent changes that can occur during pregnancy is ureterohydronephrosis (dilatation of pylon and of the renal calices) which happens in about 90% of pregnancies. If this situation is accompanied by what seems to represent a renal colic, we have to carefully evaluate the situation because our therapeutic decisions can affect both mother and fetus. Material and method. We analyzed the experience of Urology and Kidney Transplant Clinic in Iași as regards the management of the pregnant woman with symptomatic ureterohydronephrosis through the cases presented and admitted in the course of the year 2015. The group studied was represented by pregnant women admitted to whom we have analyzed the age, ureterohydronephrosis stage, gestational age and its connection with the dilatation degree and the need for a surgical maneuver during admission or in postpartum recovery. Results. The majority of the patients were between the ages of 20 and 29 years. Gestational age was relatively evenly distributed in the group studied without a linear correlation between the age of the patients and gestational age at presentation, although we observed a slight tendency for the presentation of the cases in the 2nd and 3rd quarters. We have noticed an increase of the ureterohydronephrosis degree correlated with the gestational age. Patients presented with minimal dilation had an average gestational age of 17,71 weeks, those with dilation grade I had gestational age average of 22,41 weeks, dilation grade II: 24,15 weeks and the degree III: 29 weeks. The majority of cases (72.9%) have ureterohydronephrosis on the right kidney. Of the admitted patients 45 had a favorable evolution after conservative treatment (antispastic/antibiotic) and only a number of 25 (35,7%) requiring a surgical procedure due to the unfavorable evolution, this procedure being represented by the insertion of a JJ stent. After birth only a number of 3 cases have required a therapeutic approach adapted to a stone that was persistent. Conclusions. Although ureterohydronephrosis in pregnant woman presents an increased risk of developing various complications, frequently, under conservatory treatment, progress is favorable. Otherwise the insertion of a JJ stent can be a simple and safe maneuver witch ensures a favorable status, in spite of the symptoms accompanying the wearing of an urinary stent. After delivery the patient must return to urologist for evaluation of the presence or absence of an urethral calculus that will require a subsequent therapeutic approach. The vast majority of patients have no litiasic obstacle, the simple extraction of the JJ stent being the only maneuver they will still have to bear.