Complications of pregnancy in women after childhood reimplantation for vesicoureteral reflux: an update with 25 years of followup.

Surgery for the correction of vesicoureteral reflux has been performed routinely since the early 1960s. In 1986 a large group of women who underwent childhood ureteral reimplantation surgery was contacted and surveyed concerning infections, pregnancies and other complications. A notably high rate of cystitis and pyelonephritis was found during pregnancy. Because 9 years have passed and many more pregnancies have occurred, we contacted this cohort again as well as a new cohort of historical controls to reassess long-term complications of childhood ureteral reimplantation in children. Of 67 women who underwent reimplantation with an average followup of 25 years 62 were contacted of whom 75% had urinary tract infections after becoming sexually active and 65% had urinary tract infections with pregnancies. Of 141 pregnancies 57 (40%) were complicated by urinary tract infections and 21 (15%) terminated in spontaneous abortion. Of 37 women with primary vesicoureteral reflux and no surgery with an average followup of 25.5 years there was a 15% prevalence of urinary tract infections with pregnancy in 21. Of 75 pregnancies in this group 14 (18%) terminated in spontaneous abortion. Women with urinary tract infections and reflux as children have high rates of cystitis with the onset of sexual activity whether or not they underwent reimplantation as children. Those who underwent reimplantation as children are at significant risk of urinary tract infection in pregnancy but not at a higher risk of miscarriage than the general population. Education, screening and antibiotic prophylaxis during pregnancy should be considered.