Objectives: To evaluate if fetal endoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia (CDH) using a 1.0-mm fetoscope improves neonatal outcome. Method: Between January 2006 and December 2008, a controlled study was conducted at a single center in which FETO was proposed for fetuses with severe isolated CDH (lung-to-head ratio <1.0) and liver herniation to the thoracic cavity but no other detectable anomalies at diagnosis (<26 weeks). FETO was performed under maternal epidural and fetal intramuscular anesthesia, guided by ultrasonography and 1.0-mm fetoscope between 26 and 30 weeks. All cases submitted to FETO were delivered by ex utero intrapartum therapy procedure. Postnatal therapy was the same for both treated fetuses and controls. The primary outcome was neonatal survival (up to 28 days after birth). Results: A total of 35 women met the inclusion criteria, and in 17 of them, fetal intervention was intended. However, in 1 case, it was not possible to insert the balloon inside the fetal trachea because of placental bleeding. FETO was therefore successfully performed in 16 fetuses with severe CDH. Eighteen cases received no prenatal intervention and served as the control group. Mean gestational age at diagnosis was similar in both groups (p > 0.05). Delivery occurred at 35.6 (range: 28–38) weeks in the FETO group and at 37.5 (range: 31–40) weeks (p = 0.18) among controls. Nine of 17 (52.9%) infants in the FETO group and 1 of 18 (5.6%) in the control group survived (p < 0.01). Severe pulmonary arterial hypertension was present in 8/17 (47.1%) infants from the FETO group and in 16/18 (88.9%) controls (p = 0.01). Conclusion: The present study shows that FETO using a 1.0-mm fetoscope is feasible and may improve neonatal outcome in severe CDH.

Percutaneous fetal cystoscopy is feasible using a thinner special cannula for prenatal diagnosis and therapy of LUTO. Prenatal laser ablation of the PUV under cystoscopy may prevent renal function deterioration improving postnatal outcome.

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Background The current outbreak of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection, named coronavirus disease 19 (COVID‐19), is not the first well‐known spillover of an animal originated virus to infect humans. However, one of the few to make such a fast jump in a powerful evolutionary shortcut. The incredible pattern of aggressiveness worldwide since the beginning of the outbreak is that up to 20% of those infected need hospitalization and 5% evolve to critical conditions, not limited to respiratory‐related issues, but rather to systemic involvement. Objective This study aims to summarize the current knowledge about the effects of SARS‐CoV‐2 infection on the male genitourinary tract. Materials and methods A narrative review was carried out to identify articles on the SARS‐CoV‐2 infection on the male genitourinary system. Results Considerations were made about the molecular characteristics of SARS‐CoV‐2 and immune response to coronavirus. We discussed the influence of the virus on the urinary system, potential mechanisms of COVID‐19‐ related acute kidney injury (AKI), and the role of cytokine release syndrome on the renal pathophysiology of the disease. In the male reproductive tract, it was discussed the testis' vulnerability to SARS‐CoV‐2 invasion and the possible adverse effects on its function and the seminal findings of COVID‐19. Discussion and conclusion During the COVID‐19 pandemic, an international coordinated scientific effort must arise to understand the role of the urogenital system in the SARS‐CoV‐2 infection in the clinical setting.

Amniotic fluid (AF) was described as a potential source of mesenchymal stem cells (MSCs) for biomedicine purposes. Therefore, evaluation of alternative cryoprotectants and freezing protocols capable to maintain the viability and stemness of these cells after cooling is still needed. AF stem cells (AFSCs) were tested for different freezing methods and cryoprotectants. Cell viability, gene expression, surface markers, and plasticity were evaluated after thawing. AFSCs expressed undifferentiated genes Oct4 and Nanog; presented typical markers (CD29, CD44, CD90, and CD105) and were able to differentiate into mesenchymal lineages. All tested cryoprotectants preserved the features of AFSCs however, variations in cell viability were observed. In this concern, dimethyl sulfoxide (Me2SO) showed the best results. The freezing protocols tested did not promote significant changes in the AFSCs viability. Time programmed and nonprogrammed freezing methods could be used for successful AFSCs cryopreservation for 6 months. Although tested cryoprotectants maintained undifferentiated gene expression, typical markers, and plasticity of AFSCs, only Me2SO and glycerol presented workable viability ratios.

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Fetal cystoscopy may be an option for the treatment of severe lower urinary tract obstruction 1 -7 . In the present case the use of four-dimensional (4D) ultrasonography was helpful in the identification of the urethral obstruction and guidance of percutaneous cystoscopy.A 34-year-old pregnant woman, gravida 2 para 1 (one previous vaginal delivery), was referred at 20 weeks' gestation because her male fetus presented with distended bladder, dilated proximal urethra ('keyhole sign') ( Figure 1a), bilateral hydroureters and hyperechogenic kidneys with severe hydronephrosis, ascites and anhydramnios. Amniocentesis was performed and normal fetal karyotype was observed. Renal function (sodium concentration of 120 mEq/L, chloride concentration of 95 mEq/L and osmolarity of 255 mOsm) was assessed by percutaneous puncture of the fetal right kidney. At 22 weeks' gestation fetal cystoscopy was performed under maternal epidural anesthesia and fetal anesthesia (15 µg/kg of fentanyl and 2 mg/kg pancuronium), after the parents' informed consent and the approval of the local ethics committee were obtained. A 2.2-mm slightly curved operating sheath was introduced into the fetal dilated bladder through the maternal abdomen, uterine walls and amniotic cavity under two-dimensional (2D) Figure 1 (a) Two-dimensional ultrasound image (parasagittal section) revealing a distended bladder (DB) and dilated urethra (DU) at 20 weeks' gestation. (b) Three-dimensional surface-rendered ultrasound image of fetal distended bladder (DB), dilated upper posterior urethra (DU), hydroureters (HyUr) and a septum (s) that seemed to obstruct bladder drainage. P, placenta.

Sacrococcygeal teratoma (SCT) is the commonest solid fetal tumor. Perinatal prognosis is usually favorable, but sometimes it can be complicated by fetal hydrops being responsible for high risk of mortality. Fetal therapy in such cases has so far not been established. We report a case with a giant solid SCT associated with fetal hydrops and severe heart failure. 2D- and 3D-Doppler ultrasonography revealed great vessels originated from the medial sacral artery. Percutaneous laser ablation of these vessels was performed at 24 weeks of gestation. During the procedure, severe anemia was also diagnosed (hemoglobin 4.3 g/dl). Two days later, the fetus died and pathological examination revealed local tumor necrosis and blood hemorrhage inside the mass. We suggest that in such cases, fetal surgery may not be enough, being too late, and perhaps fetal clinical therapy for anemia and heart failure could be the best option at a gestational age of less than 28 weeks.