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incontinence after right ureteral stent placement

  Please help
  I am a 28 yo female.  I have never had any major health problems.  I am 28 weeks pregnant (1st pregnancy).
  For the last month I have had severe right side pain.  (My OB reassured me that this was normal.)  Last week he finally referred me to a urologist possible kidney stone vs. hydronephrosis.  IVP showed an obstruction at L4-L5 in right ureter.  I passed on doing anything dramatic until after having a chance to pass the stone.  NO STONE.  Went to surgery for retrograde ureteroscopy w/ stone removal and possible stent placement.  No stone was found. I now have a double J stent (driving me nuts...it pokes me).  
  I am 1 week post procedure.  Still have right side pain plus incontince and retention (350 cc per us thing at uro clinic).  I have quit taking the Ditropan 5 mg TID (afraid of risks to unborn).  Urologist's only option for me was to wear an indwelling catheter for an undetermined period of time.  I was hesitant and refused until consulting my NEW HIGH RISK OB ( thanks to premature contractions after surgery)  My OB was not thrilled with an indwelling catheter.  Could further increase risk of infection (not to mention take away what dignity I have left). He suggested applying pressure over my bladder when voiding.  If sono shows residual >500cc then self catheterization.  If <500cc continue to void applying pressure at least every 2 hrs and cont Macrobid 100 mg at bed time.
  Will this retention go away after the stent is removed (remember I have never had this problem before).  How long do people self cath?  Will I have to do this the rest of my life?
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Dear Jennifer,
Hydronephrosis is dilatation of the ureter ( the tube that carries urine from the kidney to the bladder ). The common causes during pregnancy are kidney stones and compression from the enlarging uterus. The right side is most commonly affected during pregnancy. This is felt to be due the enlargement of the uterus. It does not occur on the left as often because the colon is in between the uterus and the ureter.
Pregnant women do get kidney stones. Since your hydronephrosis was associated with flank pain and x-rays are minimized in the first trimester of pregnancy, a stent was a reasonable thing to do. Stent pain and bladder irritation can occur and the degree varies from patient to patient. Since no stone was found it might be worthwhile to consider removing the stent with the knowledge that the flank pain could reoccur.
Your bladder problems are most likely related to the stent and will likely resolve after pregnancy. Patients often have variable post void residual volumes of urine in the bladder. 350cc is elevated but this may have been due to the ditropan. Now that you are not taking this medication anymore, things may resolve spontaneously. Your incontinence is almost certainly due to the stent and the resultant bladder irritation. It is important to realize that bladder infection during pregnancy puts you at risk for preterm labor. Everything done to this point has been appropriate.It is best to avoid ditropan.   Any time you have burning with urination or new symptoms suspicious for a urinary tract infection, you should be treated. This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568).
HFHS MD-KR
*keyword : hydronephrosis, pregnancy





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