Fetal Megacystis in the first trimester: Comparing management and outcomes between longitudinal bladder length groups

Ormonde, Mariana; Carrilho, Bruno; Carneiro, Rita Terezinha de Oliveira; Alves, Fátima L.; Cohen, Álvaro; Martins, Ana Teresa

doi:10.1016/j.jogoh.2022.102503

Cited by 4 publications

(4 citation statements)

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“…Chromosomal abnormalities were found by Chen et al ( 14 ) in 10% of 1,088 fetuses with megacystis, the most common being trisomy 13, 18, and 21. Other authors have reported higher figures, with differences depending on the GA at diagnosis or LBD ( 15 ). Thus, it is important to offer invasive genetic testing and karyotype analysis, which are essential for correct prenatal counseling and to define fetal prognosis.…”

Section: Discussionmentioning

confidence: 86%

Obstructive or non-obstructive megacystis: a prenatal dilemma

Mandaletti,

Cerchia,

Ruggiero

et al. 2024

Front. Pediatr.

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IntroductionDiagnosis of prenatal megacystis has a significant impact on the pregnancy, as it can have severe adverse effects on fetal and neonatal survival and renal and pulmonary function. The study aims to investigate the natural history of fetal megacystis, to try to differentiate in utero congenital lower urinary tract obstruction (LUTO) from non-obstructive megacystis, and, possibly, to predict postnatal outcome.Materials and methodsA retrospective single-center observational study was conducted from July 2015 to November 2023. The inclusion criteria were a longitudinal bladder diameter (LBD) >7 mm in the first trimester or an overdistended/thickened-walled bladder failing to empty in the second and third trimesters. Close ultrasound follow-up, multidisciplinary prenatal counseling, and invasive and non-invasive genetic tests were offered. Informed consent for fetal autopsy was obtained in cases of termination of pregnancy or intrauterine fetal demise (IUFD). Following birth, neonates were followed up at the same center. Patients were stratified based on diagnosis: LUTO (G1), urogenital anomalies other than LUTO (“non-LUTO”) (G2), and normal urinary tract (G3).ResultsThis study included 27 fetuses, of whom 26 were males. Megacystis was diagnosed during the second and third trimesters in 92% of the fetuses. Of the 27 fetuses, 3 (11.1%) underwent an abortion, and 1 had IUFD. Twenty-three newborns were live births (85%) at a mean gestational age (GA) of 34 ± 2 weeks. Two patients (neonates) died postnatally due to severe associated malformations. Several prenatal parameters were evaluated to differentiate patients with LUTO from those with non-LUTO, including the severity of upper tract dilatation, keyhole sign, oligohydramnios, LBD, and GA at diagnosis. However, none proved predictive of the postnatal diagnosis. Similarly, none of the prenatal parameters evaluated were predictive of postnatal renal function.DiscussionThe diagnosis of megacystis in the second and third trimesters was associated with live births in up to 85% of cases, with LUTO identified as the main cause of fetal megacystis. This potentially more favorable outcome, compared to the majority reported in literature, should be taken into account in prenatal counseling. Megacystis is an often misinterpreted antennal sign that may hide a wide range of diagnoses with different prognoses, beyond an increased risk of adverse renal and respiratory outcomes.

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Section: Discussionmentioning

confidence: 86%

Obstructive or non-obstructive megacystis: a prenatal dilemma

Mandaletti,

Cerchia,

Ruggiero

et al. 2024

Front. Pediatr.

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“…5 Due to the implications of a confirmed LUTO diagnosis on the child and family and the possibility of a poor prognosis, 6 40 to 53% of prospective parents may opt to terminate the pregnancy. [6][7][8] Therefore, early multidisciplinary counseling to provide realistic postnatal expectations and preparation is crucial in parental guidance and decision-making regarding pregnancy management. In addition, delivery should take place in a high-risk fetal center to ensure immediate assessment by appropriate pediatric specialties equipped to manage potential complications.…”

Section: Introductionmentioning

confidence: 99%

Trends in Management of Fetuses with Suspected Lower Urinary Tract Obstruction (LUTO): A High-Risk Fetal and Pediatric Center Experience in a Universal-Access-to-Care System

Richter,

Doktor,

Good

et al. 2023

Eur J Pediatr Surg

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Introduction Neonates with lower urinary tract obstruction (LUTO) experience high morbidity and mortality associated with the development of chronic kidney disease. The prenatal detection rate for LUTO is less than 50%, with late or missed diagnosis leading to delayed management and long-term sequelae in the remainder. We aimed to explore the trends in prenatal detection and management at a high-risk fetal center and determine if similar trends of postnatal presentations were noted for the same period. Methods Prenatal and postnatal LUTO databases from a tertiary fetal center and its associated pediatric center between 2009 and 2021 were reviewed, capturing maternal age, gestational age (GA) at diagnosis, and rates of termination of pregnancy (TOP). Time series analysis using autocorrelation was performed to investigate time trend changes for prenatally suspected and postnatally confirmed LUTO cases. Results A total of 161 fetuses with prenatally suspected LUTO were identified, including 78 terminations. No significant time trend was found when evaluating the correlation between time periods, prenatal suspicion, and postnatal confirmation of LUTO cases (Durbin–Watson [DW] = 1.99, p = 0.3641 and DW = 2.86, p = 0.9113, respectively). GA at referral was 20.0 weeks (interquartile range [IQR] 12, 35) and 22.0 weeks (IQR 13, 37) for TOP and continued pregnancies (p < 0.0001). GA at initial ultrasound was earlier in terminated fetuses compared to continued (20.0 [IQR 12, 35] weeks vs. 22.5 [IQR 13, 39] weeks, p < 0.0001). While prenatal LUTO suspicion remained consistently higher than postnatal presentations, the rates of postnatal presentations and terminations remained stable during the study years (p = 0.7913 and 0.2338), as were GA at TOP and maternal age at diagnosis (p = 0.1710 and 0.1921). Conclusion This study demonstrated that more severe cases of LUTO are referred earlier and are more likely to undergo TOP. No significant trend was detected between time and prenatally suspected or postnatally confirmed LUTO, highlighting the need for further studies to better delineate factors that can increase prenatal detection.

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“…12 Nevertheless, confronted with an unpredictable risk of severe outcomes and an uncertain prognosis, approximately half of women faced with a prenatal LUTO diagnosis opt for termination of pregnancy. 13,14 In light of the low prenatal detection rates and variability of ultrasound findings, we sought to compare the sonographic and postmortem findings in fetuses terminated for suspected LUTO and to determine the prenatal detection rates, distribution of underlying LUTO etiologies and contribution of genetic testing.…”

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confidence: 99%

“…Nevertheless, confronted with an unpredictable risk of severe outcomes and an uncertain prognosis, approximately half of women faced with a prenatal LUTO diagnosis opt for termination of pregnancy. 13,14…”

mentioning

confidence: 99%

Pathological Findings in Fetuses Terminated for Suspected Lower Urinary Tract Obstruction: Experience From a High-Risk Fetal Center in Canada

Richter,

Rickard,

Good

et al. 2024

Journal of Urology

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E.C. coordinated and supervised data collection, and critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.Data Availability: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Fetal Megacystis in the first trimester: Comparing management and outcomes between longitudinal bladder length groups

Cited by 4 publications

References 16 publications

Obstructive or non-obstructive megacystis: a prenatal dilemma

Obstructive or non-obstructive megacystis: a prenatal dilemma

Trends in Management of Fetuses with Suspected Lower Urinary Tract Obstruction (LUTO): A High-Risk Fetal and Pediatric Center Experience in a Universal-Access-to-Care System

Pathological Findings in Fetuses Terminated for Suspected Lower Urinary Tract Obstruction: Experience From a High-Risk Fetal Center in Canada

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