urovestВестник урологииUrology Herald2308-6424Rostov State Medical University10.21886/2308-6424-2020-8-1-49-54urovest-304Research ArticleДИСКУССИОННЫЕ СТАТЬИDISCUSSION PAGEНужно ли дренировать почку при гестационном пиелонефрите?Is It Necessary to Drain the Kidney with Gestational Pyelonephritis?https://orcid.org/0000-0003-2495-5760ШкодкинС. В.ShkodkinS. V.

Сергей Валентинович Шкодкин — д.м.н., доцент; профессор кафедры госпитальной хирургии Медицинского института; врач урологического отделения

тел.: +7 (4722) 50-46-07

SPIN-код 6014-5409

Sergey V. Shkodkin — M.D., Dr. Sc. (M); Assoc. Prof. (Docent); Prof., Dept. of Hospital Surgery, Medical Institute; Urologist, Urological Division

shkodkin-s@mail.ruОГБУЗ «Белгородская областная клиническая больница Святителя Иоасафа»; ФГАОУ ВО «Белгородский государственный национальный исследовательский университет» Минобрнауки РоссииРоссияBelgorod Regional Clinical Hospital of St. Joasaph; Belgorod National Research UniversityRussian Federation202018042020814954Copyright © Шкодкин С.В., 20202020Шкодкин С.В.Shkodkin S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.urovest.ru/jour/article/view/304Введение

Введение. Гестационный пиелонефрит рассматривают как осложнённую инфекцию мочевых путей. Во многих российских публикациях рекомендуется дренирование верхних мочевых путей у беременных с пиелонефритом.

Цель исследования

Цель исследования. Оценить эффективность и безопасность бездренажного ведения пациенток с пиелонефритом беременных, а также эпидемическую распространённость гестационного пиелонефрита.

Материалы и методы

Материалы и методы. Ретроспективно оценена эффективность консервативной терапии и постурального дренажа у 162 беременных с гестационным пиелонефритом за последние 3 года.

Результаты

Результаты. Наибольшая частота пиелонефрита беременных отмечена во втором триместре. Консервативная терапия оказалась эффективной у подавляющего большинства пациенток. Дренирование мочеточниковым стентом выполнено у 3,7% пациенток. В этой группе сроки госпитализации достоверно возросли.

Заключение

Заключение. Пиелонефрит беременных нельзя рассматривать как обструктивный. Бездренажное ведение пациенток с гестационным пиелонефритом должно рассматриваться как приоритетный подход.

Summary

Summary. Pyelonephritis during pregnancy is considered as a complicated urinary tract infection. Many Russian publications recommend drainage of the upper urinary tract in pregnant women with pyelonephritis.

Purpose of the study

Purpose of the study. To evaluate the effectiveness and safety of drainage-free management of patients with pregnant pyelonephritis, as well as the epidemic prevalence of pyelonephritis during pregnancy.

Materials and methods

Materials and methods. The efficacy of conservative therapy and postural drainage in 162 pregnant women with pyelonephritis over the past 3 years has been retrospectively evaluated.

Results

Results. The highest frequency of pyelonephritis during pregnancy was noted in the second trimester. Conservative therapy was effective in most patients. Ureteric stent drainage was performed in 3.7% of patients. Hospitalization period increased in this group reliably.

Conclusions

Conclusions. Pyelonephritis during pregnancy cannot be considered obstructive. Drainage-free management of pregnant women with pyelonephritis should be considered as a priority approach.

пиелонефрит беременныхгестационный пиелонефритмочеточниковый стентнефростомаосложненный гидронефроз беременныхpyelonephritis in pregnancyureteral stentnephrostomacomplicated pregnant hydronephrosisReferencesLoh K, Sivalingam N. Urinary tract infections in pregnancy. Malays Fam Physician. 200731;2(2):54‒57. PMCID: PMC4170332Loh K, Sivalingam N. Urinary tract infections in pregnancy. Malays Fam Physician. 200731;2(2):54‒57. PMCID: PMC4170332Boridy IC, Maklad N, Sandler CM. Suspected urolithiasis in pregnant women: imaging algorithm and literature review. AJR Am J Roentgenol. 1996;167(4):869‒875. https://doi.org/10.2214/ajr.167.4.8819373Boridy IC, Maklad N, Sandler CM. Suspected urolithiasis in pregnant women: imaging algorithm and literature review. AJR Am J Roentgenol. 1996;167(4):869‒875. https://doi.org/10.2214/ajr.167.4.8819373Синякова Л.А., Лоран О.Б., Косова И.В., Колбасов Д.Н., Цицаев Х.Б. Выбор метода дренирования мочевых путей при гестационном пиелонефрите. Вестник урологии. 2019;7(4):35‒42. https://doi.org/10.21886/2308-6424-2019-7-4-35-42Sinyakova L.A., Loran O.B., Kosova I.V., Kolbasov D.N., Tsitsaev H.B. Urinary Tract Drainage Selection in Case of Pyelonephritis in Pregnant Women. Urology Herald. 2019;7(4):35‒42. (In Russ.). https://doi.org/10.21886/2308-6424-2019-7-4-35-42Левченко В.В., Моргун П.П. Гестационный пиелонефрит: современная дренирующая тактика. Вестник урологии. 2019;7(3):29‒34. https://doi.org/10.21886/2308-6424-2019-7-3-29-34Levchenko V.V., Morgun Р.P. Pyelonephritis in Pregnancy: modern draining tactics. Urology Herald. 2019;7(3):29‒34. (In Russ.). https://doi.org/10.21886/2308-6424-2019-7-3-29-34Урология. Российские клинические рекомендации. Под ред. Аляева Ю.Г., Глыбочко П.В., Пушкаря Д.Ю. М.: Мед- форум; 2018: 465.Urologiya. Rossiyskiye klinicheskiye rekomendatsii [Urology. Russian Clinical Guidelines]. Pod red. [Ed.] Alyaev Yu.G., Glybochko P.V., Pushkar D.Yu. Moscow: Medforum; 2018: 465. (In Russ).Fainaru O, Almog B, Gamzu R, Lessing JB, Kupferminc M. The management of symptomatic hydronephrosis in pregnancy. BJOG. 2002 Dec;109(12):1385‒1387. https://doi.org/10.1046/j.1471-0528.2002.01545.xFainaru O, Almog B, Gamzu R, Lessing JB, Kupferminc M. The management of symptomatic hydronephrosis in pregnancy. BJOG. 2002 Dec;109(12):1385‒1387. https://doi.org/10.1046/j.1471-0528.2002.01545.xPuskar D, Balagović I, Filipović A, Knezović N, Kopjar M, Huis M, Gilja I. Symptomatic physiologic hydronephrosis in pregnancy: incidence, complications and treatment. Eur Urol. 2001;39(3):260‒263. https://doi.org/10.1159/000052449Puskar D, Balagović I, Filipović A, Knezović N, Kopjar M, Huis M, Gilja I. Symptomatic physiologic hydronephrosis in pregnancy: incidence, complications and treatment. Eur Urol. 2001;39(3):260‒263. https://doi.org/10.1159/000052449Au KK, Woo JS, Tang LC, Liang ST. Aetiological factors in the genesis of pregnancy hydronephrosis. Aust NZJ Obstet Gynaecol. 1985;25(4):248‒251. https://doi.org/10.1111/j.1479-828x.1985.tb00737.xAu KK, Woo JS, Tang LC, Liang ST. Aetiological factors in the genesis of pregnancy hydronephrosis. Aust NZJ Obstet Gynaecol. 1985;25(4):248‒251. https://doi.org/10.1111/j.1479-828x.1985.tb00737.xWolf P, Le Lanne D, Menger I, Bsaibes A, Reinhardt W, Dreyfuss J, Bollack C. The upper urinary tract in pregnant women. Physiopathologic, ultrasonic and urographic study. Ann Urol (Paris). 1984;18(5):347‒349. PMID: 6397120Wolf P, Le Lanne D, Menger I, Bsaibes A, Reinhardt W, Dreyfuss J, Bollack C. The upper urinary tract in pregnant women. Physiopathologic, ultrasonic and urographic study. Ann Urol (Paris). 1984;18(5):347‒349. PMID: 6397120Karabulut N, Karabulut A. Colour Doppler evaluation of ureteral jets in normal second and third trimester pregnancy: effect of patient position. Br J Radiol. 2002;75(892):351‒355. https://doi.org/10.1259/bjr.75.892.750351Karabulut N, Karabulut A. Colour Doppler evaluation of ureteral jets in normal second and third trimester pregnancy: effect of patient position. Br J Radiol. 2002;75(892):351‒355. https://doi.org/10.1259/bjr.75.892.750351Burke BJ, Washowich TL. Ureteral jets in normal second- and third-trimester pregnancy. J Clin Ultrasound. 1998;26(9):423‒426. https://doi.org/10.1002/(sici)1097-0096(199811/12)26:9<423::aid-jcu1>3.0.co;2-pBurke BJ, Washowich TL. Ureteral jets in normal second- and third-trimester pregnancy. J Clin Ultrasound. 1998;26(9):423‒426. https://doi.org/10.1002/(sici)1097-0096(199811/12)26:9<423::aid-jcu1>3.0.co;2-pBoridy IC, Maklad N, Sandler CM. Suspected urolithiasis in pregnant women: imaging algorithm and literature review. AJR Am J Roentgenol. 1996;167(4):869‒875. https://doi.org/10.2214/ajr.167.4.8819373Boridy IC, Maklad N, Sandler CM. Suspected urolithiasis in pregnant women: imaging algorithm and literature review. AJR Am J Roentgenol. 1996;167(4):869‒875. https://doi.org/10.2214/ajr.167.4.8819373Witkin SS. The vaginal microbiome, vaginal anti-microbial defence mechanisms and the clinical challenge of reducing infection- related preterm birth. BJOG. 2015;122(2):213‒218. https://doi.org/10.1111/1471-0528.13115Witkin SS. The vaginal microbiome, vaginal anti-microbial defence mechanisms and the clinical challenge of reducing infection- related preterm birth. BJOG. 2015;122(2):213‒218. https://doi.org/10.1111/1471-0528.13115Solt I. The human microbiome and the great obstetrical syndromes: a new frontier in maternal-fetal medicine. Best Pract Res Clin Obstet Gynaecol. 2015;29(2):165‒175. https://doi.org/10.1016/j.bpobgyn.2014.04.024Solt I. The human microbiome and the great obstetrical syndromes: a new frontier in maternal-fetal medicine. Best Pract Res Clin Obstet Gynaecol. 2015;29(2):165‒175. https://doi.org/10.1016/j.bpobgyn.2014.04.024Forson AO, Tsidi WB, Nana-Adjei D, Quarchie MN, Obeng- Nkrumah N. Escherichia coli bacteriuria in pregnant women in Ghana: antibiotic resistance patterns and virulence factors. BMC Res Notes. 2018;11(1):901. https://doi.org/10.1186/s13104-018-3989-yForson AO, Tsidi WB, Nana-Adjei D, Quarchie MN, Obeng- Nkrumah N. Escherichia coli bacteriuria in pregnant women in Ghana: antibiotic resistance patterns and virulence factors. BMC Res Notes. 2018;11(1):901. https://doi.org/10.1186/s13104-018-3989-yOli AN, Akabueze VB, Ezeudu CE, Eleje GU, Ejiofor OS, Ezebialu IU, Oguejiofor CB, Ekejindu IM, Emechebe GO, Okeke KN. Bacteriology and Antibiogram of Urinary Tract Infection Among Female Patients in a Tertiary Health Facility in South Eastern Nigeria. Open Microbiol J. 2017;11:292‒300. PMCID: PMC5688387 https://doi.org/10.2174/1874285801711010292Oli AN, Akabueze VB, Ezeudu CE, Eleje GU, Ejiofor OS, Ezebialu IU, Oguejiofor CB, Ekejindu IM, Emechebe GO, Okeke KN. Bacteriology and Antibiogram of Urinary Tract Infection Among Female Patients in a Tertiary Health Facility in South Eastern Nigeria. Open Microbiol J. 2017;11:292‒300. PMCID: PMC5688387 https://doi.org/10.2174/1874285801711010292

The authors declare that there are no conflicts of interest present.