V45 Fetal cystoscopy for lower urinary tract obstruction – initial experience of a single center

Ruano, Rodrigo; Duarte, Sérgio; Bunduki, Victor; Martins, Antônio Carlos Pereira; Srougi, Miguel; Zugaib, Marcelo

doi:10.1016/s0020-7292(09)61482-x

Cited by 17 publications

(53 citation statements)

References 24 publications

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“…Fetal cystoscopy appears promising as both a diagnostic and therapeutic intervention. However, it remains technically challenging and requires refinements in current equipment to improve its overall success rate [19][20][21] . In our study, despite a trend towards increased overall success rate with F-VASI, there was no statistically significant difference compared with US-VASI (90 vs. 77%, p = 0.3).…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Vesicoamniotic Shunt Insertion in an Inanimate Model: Comparison of Fetoscopic and Ultrasound-Guided Techniques

Humphrey

Grieci²,

Schmidt³

et al. 2011

Fetal Diagn Ther

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Objectives: To determine the feasibility of fetoscopic vesicoamniotic shunt insertion (F-VASI) in an inanimate model and to compare F-VASI to ultrasound (US)-guided VASI (US-VASI) with respect to accuracy of shunt placement and overall success rate. Methods: An inanimate second-trimester fetus with a replaceable bladder balloon was suspended in a pressurized water tank and localized with US. Fetal position was randomized, the operator was blinded and a 5-Fr Harrison Shunt® decompressed the bladder in both groups. Thirty shunt insertions were performed per group. Results: Procedure time was longer for F-VASI (15.0 vs. 2.8 min, p < 0.05), although it decreased with practice. F-VASI and US-VASI were similar for adequate depth of insertion (27/30 vs. 27/30, p = 1.0), placement within 1 cm of midline (27/30 vs. 25/30, p = 0.42), bladder puncture (28/30 vs. 28/30, p = 1.0), and overall success rate (27/30 vs. 23/30, p = 0.3). Conclusions: F-VASI is feasible in an inanimate model. Overall success rate was similar between the groups, although procedure time was longer for F-VASI. Further study is required to determine whether shunt migration is decreased with F-VASI.

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Section: Discussionmentioning

confidence: 99%

Feasibility of Vesicoamniotic Shunt Insertion in an Inanimate Model: Comparison of Fetoscopic and Ultrasound-Guided Techniques

Humphrey

Grieci²,

Schmidt³

et al. 2011

Fetal Diagn Ther

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“…Uma das extremidades do dreno fica localizada dentro da bexiga e a outra na cavidade amniótica, permitindo a eliminação da urina fetal. A técnica endoscópica oferece a possibilidade de tratar definitivamente as obstruções baixas; o fetoscópio é inserido na bexiga e, sob visualização direta, são aplicadas técnicas de destruição mecânica das valvas, restaurando o fluxo natural de urina 56,57 .…”

Section: Iv) Intervenções Intrauterinas Em Casos De Obstrução Do Tratunclassified

Cirurgia fetal no contexto atual

Rocha

Filho

Bunduki

et al. 2018

Rev. Med. (São Paulo)

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RESUMO:A cirurgia fetal é, hoje, uma realidade em grandes centros especializados na área da medicina fetal. Surgiu por volta da década de 1960, inicialmente atrelada à necessidade de melhor conhecer e entender as patologias fetais, e teve desenvolvimento exponencial impulsionado pelo aprimoramento das técnicas diagnósticas pré-natais. Foi aos poucos se consolidando e tornando-se o tratamento de escolha para algumas patologias específicas, mudando definitivamente o curso dessas doenças. Nesse estudo, encontra-se um breve histórico das cirurgias fetais mais comumente realizadas em todo o mundo, como elas surgiram e como foram evoluindo com o passar do tempo, os principais estudos que as validaram e a técnica cirúrgica mais amplamente utilizada em cada caso. Entre as principais cirurgias, são citadas a fotocoagulação a laser de anastomoses placentárias na síndrome de transfusão feto-fetal, a correção intrauterina a céu aberto da mielomeningocele fetal e a oclusão endotraqueal fetal por balão nos casos de hérnia diafragmática congênita. Também são abordados cirurgias e procedimentos cujos benefícios são menos evidentes e os resultados ainda um tanto controversos, como as intervenções urinárias nos casos de obstrução ao trato urinário inferior, procedimentos cardíacos em casos de estenose aórtica crítica, derivações tóracoamnióticas para tratamento de derrames pleurais compressivos, além de ressecções intrauterinas de teratomas sacrococcígeos e de massas pulmonares. Também é feita uma avaliação a respeito do futuro da cirurgia fetal.Descritores: Feto/cirurgia; Fetoscopia. ABSTRACT:Fetal surgery is now a reality in large centers that specialize in the field of fetal medicine. Fetal surgery emerged in the 1960s, primarily from the need to better identify and understand fetal pathologies, and its exponential development was driven by improvements in prenatal diagnostic techniques. Fetal surgery gradually became the main treatment for specific fetal pathologies, changing the course of these diseases. This study summarizes the history of the fetal surgeries that are most commonly performed worldwide, how they started and how they evolved over time, the main validation trials and the most widely used surgical technique in each case. The main surgeries include laser photocoagulation of placental anastomoses in twin-to-twin transfusion syndrome, in utero repair of fetal myelomeningocele and fetal endotracheal occlusion in cases of congenital diaphragmatic hernia. Other surgeries and procedures, whose benefits are less clear and whose results are still somewhat controversial, such as urinary interventions in cases of lower urinary tract obstruction, cardiac procedures in cases of critical aortic stenosis, thoracoamniotic shunts for the treatment of massive pleural effusions and intrauterine resection of sacrococcygeal teratomas and pulmonary masses, are also cited. The future of fetal surgery is also assessed.

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“…Both fetoscopic antegrade catheterisation and hydro-or laser ablation of urethral valves have been described (Quintero et al, 1995;Welsh et al, 2003). Ruano et al recently reported a large series in this journal, so that this technique has also outgrown its infancy (Ruano et al, 2010).…”

Section: Luto and Early Applications Of Shuntingmentioning

confidence: 99%

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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V45 Fetal cystoscopy for lower urinary tract obstruction – initial experience of a single center

Cited by 17 publications

References 24 publications

Feasibility of Vesicoamniotic Shunt Insertion in an Inanimate Model: Comparison of Fetoscopic and Ultrasound-Guided Techniques

Feasibility of Vesicoamniotic Shunt Insertion in an Inanimate Model: Comparison of Fetoscopic and Ultrasound-Guided Techniques

Cirurgia fetal no contexto atual

The making of fetal surgery

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