Fetal cystoscopy for severe lower urinary tract obstruction—initial experience of a single center

Ruano, Rodrigo; Duarte, Sérgio; Bunduki, Victor; Giron, Amilcar Martins; Srougi, Miguel; Zugaib, Marcelo

doi:10.1002/pd.2418

Cited by 75 publications

(59 citation statements)

References 29 publications

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“…Cystoscopy showed significantly better results in terms of the survival rate (62 vs. 11%) and postnatal normal renal function (62 vs. 11%) [22]. The findings we reported are similar to those of Ruano et al [22]. A recent systematic review has concluded that available evidence is still small and consequently fetal cystoscopy for LUTO should still be offered as an experimental intervention.…”

Section: Discussionsupporting

confidence: 80%

“…Later, Welch et al reported successful treatment in 6 of 10 fetuses with a purely cystoscopic approach with hydro-ablation or guidewire passage through the urethra [20]. More recently, Ruano et al [22] reported 11 cases with the same approach as in this study, where results were compared with 12 cases managed expectantly. Cystoscopy showed significantly better results in terms of the survival rate (62 vs. 11%) and postnatal normal renal function (62 vs. 11%) [22].…”

Section: Discussionmentioning

confidence: 81%

“…More recently, Ruano et al [22] reported 11 cases with the same approach as in this study, where results were compared with 12 cases managed expectantly. Cystoscopy showed significantly better results in terms of the survival rate (62 vs. 11%) and postnatal normal renal function (62 vs. 11%) [22]. The findings we reported are similar to those of Ruano et al [22].…”

Section: Discussionmentioning

confidence: 99%

“…2 and 3). Urethral patency was examined immediately postprocedure either by catheterization or by power Doppler evaluation after instilling Ringer solution into the bladder, as has been referred [17,20,22]. …”

Section: Methodsmentioning

confidence: 99%

“…Theoretically, cystoscopic therapy addresses the mechanic problem causing the obstruction and if successful it entails a single procedure. During recent years, two series with 10 [21] and 11 [22] cases have been published. Preliminary experience results suggest that cystoscopic urethral deobstruction is feasible in a majority of cases and that it could achieve similar or slightly better results than those reported with shunt decompression [21,22].…”

Section: Introductionmentioning

confidence: 99%

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Laser Ablation of Posterior Urethral Valves by Fetal Cystoscopy

et al. 2015

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Objective: To report the results of fetal cystoscopic laser ablation of posterior urethral valves (PUV) in a consecutive series in two referral centers. Methods: Twenty pregnant women with a presumptive isolated PUV were treated with fetal cystoscopy under local anesthesia. Identification and fulguration of the PUV by one or several firing-contacts with diode laser were attempted. Perinatal and long-term outcomes were prospectively recorded. Results: The median gestational age at procedure was 18.1 weeks (range 15.0-25.6), and median operation time was 24 min (range 15-40). Access to the urethra was achieved in 19/20 (95%) cases, and postoperative, normalization of bladder size and amniotic fluid was observed in 16/20 (80%). Overall, there were 9 (45%) terminations of pregnancy and 11 women (55%) delivered a liveborn baby at a mean gestational age of 37.3 (29.1-40.2) weeks. No infants developed pulmonary hypoplasia and all were alive at 15-110 months. Eight (40% of all fetuses, 72.7% of newborns) had normal renal function and 3 (27.3%) had renal failure awaiting renal transplantation. Conclusion: Fetoscopic laser ablation for PUV can achieve bladder decompression and amniotic fluid normalization with a single procedure in selected cases with anyhydramnios. There is still a significant risk of progression to renal failure pre or postnatally.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Laser Ablation of Posterior Urethral Valves by Fetal Cystoscopy

et al. 2015

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NOTES and Pregnancy: Where we are and where we could go

Bourdel

Althaus

2012

Natural Orifice Translumenal Endoscopic Surgery (NOTES)

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The making of fetal surgery

et al. 2010

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Fetal diagnosis prompts the question for fetal therapy in highly selected cases. Some conditions are suitable for in utero surgical intervention. This paper reviews historically important steps in the development of fetal surgery. The first invasive fetal intervention in 1963 was an intra-uterine blood transfusion. It took another 20 years to understand the pathophysiology of other candidate fetal conditions and to develop safe anaesthetic and surgical techniques before the team at the University of California at San Francisco performed its first urinary diversion through hysterotomy. This procedure would be abandoned as renal and pulmonary function could be just as effectively salvaged by ultrasound-guided insertion of a bladder shunt. Fetoscopy is another method for direct access to the feto-placental unit. It was historically used for fetal visualisation to guide biopsies or for vascular access but was also abandoned following the introduction of high-resolution ultrasound. Miniaturisation revived fetoscopy in the 1990s, since when it has been successfully used to operate on the placenta and umbilical cord. Today, it is also used in fetuses with congenital diaphragmatic hernia (CDH), in whom lung growth is triggered by percutaneous tracheal occlusion. It can also be used to diagnose and treat urinary obstruction. Many fetal interventions remain investigational but for a number of conditions randomised trials have established the role of in utero surgery, making fetal surgery a clinical reality in a number of fetal therapy programmes. The safety of fetal surgery is such that even non-lethal conditions, such as myelomeningocoele repair, are at this moment considered a potential indication. This, as well as fetal intervention for CDH, is currently being investigated in randomised trials.

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Fetal cystoscopy for severe lower urinary tract obstruction—initial experience of a single center

Abstract: 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.

Cited by 75 publications

References 29 publications

Laser Ablation of Posterior Urethral Valves by Fetal Cystoscopy

Laser Ablation of Posterior Urethral Valves by Fetal Cystoscopy

NOTES and Pregnancy: Where we are and where we could go

The making of fetal surgery

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