Management of Pregnancy and Delivery After Augmentation Cystoplasty: A Novel Surgical Technique Using the Sigmoid Colon With Retroperitoneal Mesentery Placement Optimized for Cesarean Section

OBJECTIVES: To examine pregnancy and delivery outcomes in women who underwent sigmoid colon cystoplasty with retroperitoneal mesentery placement, a novel surgical technique designed to reduce cesarean section (CS) complications. METHODS: A retrospective review at three institutions identified women who conceived after augmentation cystoplasty (AC). Data included pregnancy-related complications (hydronephrosis, urinary tract infections, and urinary incontinence), delivery-related outcomes, and intraoperative findings at CS. RESULTS: Six pregnancies occurred in five patients after AC; three underwent sigmoid colon cystoplasty with retroperitoneal mesentery placement, while two underwent conventional ileocystoplasty. Median age at AC was 11 years (range, 7-14 years). Hydronephrosis (4 pregnancies, 66.7%) and pyelonephritis (3, 50%) were most frequent, but no patient required nephrostomy or ureteral stenting. Urinary incontinence worsened in two pregnancies but resolved postpartum. Magnetic resonance imaging (MRI) before delivery provided anatomical information on four pregnancies. All deliveries were by CS, including five emergency procedures. In both ileocystoplasty patients, the uterus was covered by the mesentery of the augmented ileal segment, requiring a high uterine incision and careful vascular pedicle preservation. In contrast, the uterus was free of mesenteric coverage in sigmoid colon cystoplasty patients, and no intraoperative vascular pedicle or bladder injuries occurred. CONCLUSIONS: Pregnancy and delivery after AC require multidisciplinary management. Pre-delivery MRI may facilitate delivery planning. In this limited cohort, sigmoid colon cystoplasty with retroperitoneal mesentery placement appeared to allow safe cesarean delivery without vascular pedicle or augmented bladder injury. Larger studies are warranted to confirm these preliminary findings.