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

Abstract

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.

Prise en charge prénatale des obstacles sous-vésicaux

“…Plusieurs études, dont l'essai contrôlé randomisé PLUTO (percutaneous shunting in lower urinary tract obstruction), ont montré un bénéfice du drain vésico-amniotique sur la survie périnatale, sans bénéfice sur la fonction rénale postnatale [27]. Sur le des guides (de type « road runner ») permettant de perforer la valve et des ballons de dilatation endoscopique permettant de dilater l'orifice urétral restant [29,33,34]. Certaines équipes ont également rapporté l'utilisation de l'hydro-ablation 11…”

Biometric and morphological features on magnetic resonance imaging of fetal bladder in lower urinary tract obstruction: new perspectives for fetal cystoscopy

“…Despite overly optimistic reports on the matter, these attempts have been, for the most part, unsuccessful, due to failure during cystoscopy to visualize the anatomy sufficiently clearly. Several authors agree that the anatomy of a distended bladder and inadequate instrumentation account for most technical limitations of fetal cystoscopy 2–4 . Development of an appropriate fetal cystoscope that would allow us to overcome these anatomical constraints is important, and remains to be achieved 5 .…”

Urethroplasty with balloon catheterization in fetal lower urinary tract obstruction: observational study of 10 fetuses

“…18,24 The disadvantage of both VAS and endoscopy are significant rates of PPROM and premature delivery. Despite technical difficulties and considerable fetal mortality laser endoscopy seems to be superior to VAS because it is more efficient in preventing kidney insufficiency in survivors and can be used in the diagnosis of the etiology of LUTO 24 .. We report the development of a novel approach to prenatal treatment of LUTO, which involves fetal urethroplasty with a coronary angioplasty balloon catheter, 19 and present the outcome of 10 fetuses treated by this method in our center.…”

“…We present a novel method for the prenatal treatment of LUTO, which involves fetal urethroplasty using a coronary angioplasty balloon catheter 20 , and report the outcome of 10 fetuses treated with this method in our center.…”