Laser Ablation of Posterior Urethral Valves by Fetal Cystoscopy

Martínez, José María Blázquez; Masoller, N.; Devlieger, Roland; Passchyn, Esther; Gómez, O.; Rodó, J.; Deprest, Jan; Gratacós, E.

doi:10.1159/000367805

Cited by 32 publications

(19 citation statements)

References 32 publications

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“…In the present series, one case of PUV diagnosed at fetal cystoscopy was revised to be a hypoperistalsis-microcolon-megabladder syndrome. A similar case has been already reported in the series of Martinez et al 33 Laser fulguration cannot improve the urological outcome in this case, and the prognosis of this condition is totally different from isolated PUV.…”

Section: Discussionsupporting

confidence: 87%

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Two‐year outcomes after diagnostic and therapeutic fetal cystoscopy for lower urinary tract obstruction

et al. 2016

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Objectives Our objective is to report long-term outcome after fetal cystoscopy for lower urinary tract obstruction (LUTO), as well as to investigate the accuracy of fetal cystoscopy in diagnosing the cause of bladder outlet obstruction.Methods This is a retrospective cohort study of all fetuses who underwent cystoscopy for prenatal diagnosis of LUTO in three tertiary referral centers. Fetal diagnostic cystoscopy was performed to determine prenatally the cause of LUTO and to ablate the posterior urethral valves (PUV).Results A total of 50 fetal cystoscopies were performed, revealing PUV in 31 (62%) fetuses, urethral atresia (UA) in 14 (28%) fetuses, and urethral stenosis (US) in 5 (10%) fetuses. Two fetuses had trisomy 18 diagnosed after fetal cystoscopy and were excluded from the present analysis. Fetal cystoscopy was accurate in the diagnosis of the etiology of LUTO in 32/35 (91.4%). There were no survivors in the UA group. One fetus with US underwent urethral stenting and survived with normal renal function at 2 years of life. Among the infants with PUV, 17/30 (56.7%) infants survived, and 13/17 (76.5%) had normal renal function at 1 year of life; 15/28 (53.6%) infants survived, and 11/15 (73.3%) had normal renal function at 2 years.Conclusions Fetal cystoscopy is accurate in the diagnosis of the etiology of LUTO and serves as a guide to the specific prenatal treatment. This procedure is associated with modest long-term survival (54%) but with adequate preserved normal renal function in two thirds of the infants among fetuses with PUV.

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Section: Discussionsupporting

confidence: 87%

“…Fetal cystoscopy is still a challenging procedure; the risk for a urinary fistula is around 10%. 26,33 Technical aspects definitely need to be optimized. Other techniques should be investigated (microscissors, guidewire, and balloon disruption).…”

Section: Discussionmentioning

confidence: 99%

Two‐year outcomes after diagnostic and therapeutic fetal cystoscopy for lower urinary tract obstruction

et al. 2016

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“…Recurrence was reported in three cases at 1 -2 weeks due to blockage of the shunt passage in one case, and in the other two cases, the shunts openings were blocked by the uterine wall due to PROM and anhydramnios. Successful shunting in LUTO cases has been reported in other studies [25] [26] [27]. Also, the recurrence due to a migration of the shunt has been reported [25] [26].…”

Section: Discussionmentioning

confidence: 65%

Evaluation of Fetoscopy Role in Fetal Surgery and Fetal Medicine

Elbanna¹,

Oun²,

Ellatif³

et al. 2018

OJOG

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Introduction: This study aimed to evaluate, discuss and illustrate the role of fetoscopy diagnostically and therapeutically. Material and Methods: This study was conducted in private center in under the supervision of the professors of Azhar University, Egypt from Dec-2012 to Mar-2017. Women with confirmed fetal congenital malformations, and willing to do fetoscopy were recruited. Fetoscopy was attempted in all cases to treat the underlying fetal conditions. Follow up was made until delivery. Results: Twenty patients with 22 fetuses were included in this study with different congenital anomalies. Therapeutic drainage or coagulation was made in all cases. In cases of lower urinary tract obstruction, fetoscopy confirmed pre-suspected urethral atresia and changed the diagnosis from complete PUV to urethral atresia in some cases. The procedure succeeded in all cases. However, the ongoing success rate was 17 (77.3%) of fetuses. The overall number of live birth was 11 fetuses (50%). Overall, 15 (75%) of the 20 patients experienced some complication withpreterm labor the most prevalent 15 (75%). Conclusion: Fetoscopy can diagnose and differentiate between posterior urethral valve (PUV) and atresia, and manage well-selected cases of twin to twin transfusion syndrome (TTTS), and have a reasonable survival rate in lower urinary tract obstruction (LUTO).

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“…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 who survived developed pulmonary hypoplasia and all were alive at 15-110 months [17]. Johnson et al [18] in the cohort study on LUTO in USA reported even higher percentage of perinatal survival (97%), but surprisingly dialysis was required in 32% of patients.…”

Section: Discussionmentioning

confidence: 95%

Neonatal survival and kidney function after prenatal interventions for obstructive uropathies

et al. 2019

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Objectives: Prenatal interventions in LUTO (lower urinary tract obstruction) usually are still question of a debate between gynaecologist and paediatric nephrologist. We aimed the study to assess the early survival rate and renal outcome in LUTO foetuses. Material and methods: The study was a prospective data analysis of 39 foetuses from singleton pregnancies. All pregnant women with LUTO in the foetus were qualified for VAS based on a local practice. The mean time of first urine analysis ranged between 13-30 weeks of pregnancy. Primary end-point analysis included live birth, 28d-survival, pulmonary and renal function assessment in neonatal period. Results: From initial number of 39, six patients miscarried before the procedure was performed. Overall, 33 VAS were performed at the mean 21 week of pregnancy (range 14-30 weeks). 25/39 foetuses survived until delivery. Three neonates died in first 3 days of life. In the first month 3 children required peritoneal dialysis, but at 28 day all children were dialysis-free. Overall survival rate at 28 day was 56%. Renal function preservation of the initial group (39) turned out to be low-18% (7/39). Conclusions: Our study showed average survival curves and complications. LUTO in the foetus had mostly unfavourable outcome in the neonatal period. The prenatal intervention did not increase it significantly and did not guarantee the preservation of normal kidney function.

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Laser Ablation of Posterior Urethral Valves by Fetal Cystoscopy

Cited by 32 publications

References 32 publications

Two‐year outcomes after diagnostic and therapeutic fetal cystoscopy for lower urinary tract obstruction

Two‐year outcomes after diagnostic and therapeutic fetal cystoscopy for lower urinary tract obstruction

Evaluation of Fetoscopy Role in Fetal Surgery and Fetal Medicine

Neonatal survival and kidney function after prenatal interventions for obstructive uropathies

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