Early fetal cystoscopy for first‐trimester severe megacystis

Ruano, Rodrigo; Yoshisaki, C. T.; Salustiano, Eugênia Maria Assunção; Giron, Amilcar Martins; Srougi, Miguel; Zugaib, Marcelo

doi:10.1002/uog.8963

Cited by 54 publications

(68 citation statements)

References 22 publications

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“…Unfortunately, the results presented in this series reflect the limit of an earlier intervention, since it is not possible at this stage neither to determine the cause of LUTO nor to investigate precisely for associated anomalies. Although early intervention seems to prevent renal damage, the general prognosis in early severe LUTO is rather poor due to long-term morbidity and therefore conservative treatment or even pregnancy termination may be considered instead of any form of intrauterine intervention Taking into consideration the indisputable value of causative treatment which is relieving of the obstruction in fetal urethra and restoring the normal micturition in the fetal life in fetuses after early VAS other procedure like fetal cystoscopy or catheterization could be considered in later pregnancy, when it becomes technically possible [9,10,22,23].…”

Section: Discussionmentioning

confidence: 99%

Early vesico-amniotic shunting — does it change the prognosis in fetal lower urinary tract obstruction diagnosed in the first trimester?

Dębska¹,

Kretowicz²,

Olędzka³

et al. 2017

Ginekol Pol

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Objectives: The aim of the study was to assess the outcome of vesico-amniotic shunting performed before 16 weeks of pregnancy in fetuses with severe megacystis diagnosed in the first trimester of pregnancy. Material and methods:Between January 2008 and October 2012 severe megacystis with the bladder length > 15 mm was diagnosed in 17 fetuses. The procedure of early vesico-amniotic shunting (VAS) was offered to 8 patients with presumably isolated LUTO.The procedure of VAS was performed in 6 fetuses. Before the intervention one or two procedures of vesicocentesis and urine analysis were performed. Results:In all treated cases shunts provided urinary tract decompression. All babies were born prematurely, 2 of them died due to premaurity, 3 of them survived and have normal renal function at the age of 5-6 years. In 4/5 children accompanying malformations were later diagnosed, in 1 born prematurely neonate necropsy was not performed. Conclusions:Our results suggest that early vesico-amniotic shunting in fetal LUTO is feasible and may potentially prevent not only pulmonary hypoplasia but also renal insufficiency. However, the rationale of the procedure needs further investigation due to a high risk of long-term morbidity and co-existing malformations in children Before offering the therapy detailed counseling of the parents about the possible pros and cons of the therapy is necessary.

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Section: Discussionmentioning

confidence: 99%

Early vesico-amniotic shunting — does it change the prognosis in fetal lower urinary tract obstruction diagnosed in the first trimester?

Dębska¹,

Kretowicz²,

Olędzka³

et al. 2017

Ginekol Pol

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“…In the future, specific genetic testing may help to clarify this diagnosis. A promising method to increase diagnostic accuracy seems to be fetal cystoscopy [12,14,35,36] . It cannot only be used for diagnostic purposes but also as a treatment option especially when it is associated with laser [37] .…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, careful postnatal examination (autopsy included) is important to increase our understanding about this particular pathology and helping us in better counselling our patients. Fetal cystoscopy could indeed improve both diagnosis and treatment [12][13][14] , but is unfortunately not always available even in tertiary care centers. Moreover, this method has a longer learning curve and is associated with more complications (death, ascites) than VC or VAS [12] .…”

Section: Introductionmentioning

confidence: 99%

Fetal Megacystis: Experience of a Single Tertiary Center in Switzerland over 20 Years

Brochut¹,

Thomann²,

Kluwe

et al. 2014

Fetal Diagn Ther

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Objectives: Megacystis (MC) is rare and often associated with other structural and chromosomal anomalies. In euploid cases with early oligohydramnios, prognosis is poor mainly due to pulmonary hypoplasia and renal damage. We report our experience of the past 20 years. Methods: A retrospective review of cases with prenatally diagnosed MC was performed. Complete prenatal as well as postnatal medical records from 1989 to 2009 were reviewed focusing on diagnostic precision, fetal interventions [vesicocentesis (VC), vesicoamniotic shunt (VAS)], short- and long-term outcome, and potential prognostic factors. Results: 68 cases were included. Follow-up was available in 54 cases (9 girls and 45 boys including 3 cases with aneuploidy). We found 39 isolated MC at sonography (5 girls and 34 boys). 24 fetuses with isolated MC underwent VC and VAS at 19.6 ± 6.3 and 20 ± 4.9 weeks of gestation, respectively. Survival rate was higher in male than in female fetuses (51 vs. 33%). Renal problems occurred in 4/14 prenatally treated fetuses and in 1/10 when cases with prune belly syndrome (PBS) were excluded from the analysis. Conclusions: Our study shows that a careful selection of cases with MC excluding fetuses with PBS and early treatment has still the potential to improve outcome.

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“…LUTO is usually diagnosed during routine ultrasound in the second trimester, except from the most severe forms which are detected already in the first trimester [6]. Typical symptoms of LUTO include megacystis with a keyhole sign, bilateral hydronephrosis with or without cystic renal changes, and oligohydramnios or anhydramnios.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound guided balloon catheterisation: a new method of fetal lower urinary tract obstruction management

et al. 2017

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Objectives: Fetal lower urinary tract obstruction (LUTO), most often associated with presence of posterior urethral valves, poses high risk of perinatal mortality or postnatal renal failure. Looking for a method of causative treatment we have developed a technique of fetal urethroplasty with a coronary angioplasty balloon catheter inserted under an ultrasonographic guidance via an 18-gauge needle introduced transabdominally to fetal bladder. Material and methods:We have used this procedure in three women with singleton pregnancies (two primiparas and one multipara, 32-35 years of age), diagnosed with fetal megacystis at 12-16 weeks of gestation. Urethral catheterization was carried out at 16-18 weeks and an unobstructed urine flow was achieved in all three cases immediately after the procedure, followed by a resolution of megacystis and normalization of amniotic fluid volume. Results:In all three cases, the post-procedure period was uneventful. In the first two fetuses, amniotic fluid volume remained normal until 30 weeks of gestation when a gradual development of oligohydramnios and some signs of renal cystic dysplasia were observed. Nevertheless, both pregnancies were continued till term (37 and 39 weeks, respectively) and two boys without signs of pulmonary hypoplasia were delivered. The third patient is currently 25 weeks pregnant; volume of amniotic fluid in her fetus is normal and no signs of urinary flow obstruction or renal dysplasia have been recorded thus far. Conclusions:Although some technical aspects of the procedure still need to be established, it seems worth consideration as a form of potentially least traumatic intrauterine intervention in fetuses with lower urinary tract obstruction.

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Early fetal cystoscopy for first‐trimester severe megacystis

Abstract: Objectives To report the feasibility of early fetal cystoscopy for the prenatal diagnosis and therapy of severe first-trimester megacystis. Methods

Cited by 54 publications

References 22 publications

Early vesico-amniotic shunting — does it change the prognosis in fetal lower urinary tract obstruction diagnosed in the first trimester?

Early vesico-amniotic shunting — does it change the prognosis in fetal lower urinary tract obstruction diagnosed in the first trimester?

Fetal Megacystis: Experience of a Single Tertiary Center in Switzerland over 20 Years

Ultrasound guided balloon catheterisation: a new method of fetal lower urinary tract obstruction management

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