1
|
Cassart M. Fetal uropathies: pre- and postnatal imaging, management and follow-up. Pediatr Radiol 2023; 53:610-620. [PMID: 35840694 DOI: 10.1007/s00247-022-05433-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/15/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
Abstract
Congenital uropathies are the most common fetal anomalies. They include a wide spectrum of anomalies ranging from mild pelvis dilation to complex urinary tract malformations. Prenatal imaging not only allows for their diagnosis but, in experienced hands, it can differentiate obstructive from refluxing or malformative uropathies. Such precise prenatal information allows for intervention before birth in select cases or for adapting the postnatal workup to provide a better long-term outcome. For the different types of congenital uropathies, we describe their prenatal presentations on US and the complementary role of fetal MRI where indicated. We correlate these findings with postnatal workup and summarize the updated neonatal diagnostic and clinical/surgical management.
Collapse
Affiliation(s)
- Marie Cassart
- Radiology Department, Iris South Hospitals, Site Elterbeek-Ixelles, 63 Rue Jean Paquot, 1050, Brussels, Belgium.
| |
Collapse
|
2
|
Abstract
The most severe forms of congenital anomalies of the kidney and urinary tract present in fetal life with early pregnancy renal anhydramnios and are considered lethal due to pulmonary hypoplasia without fetal therapy. Due to the high rate of additional structural anomalies, genetic abnormalities, and associated syndromes, detailed anatomic survey and genetic testing are imperative when stratifying which pregnancies are appropriate for fetal intervention. Restoring amniotic fluid around the fetus is the principal goal of prenatal treatment. The ongoing multi-center Renal Anhydramnios Fetal Therapy (RAFT) trial is assessing the safety and efficacy of serial amnioinfusions to prevent pulmonary hypoplasia so that the underlying renal disease can be addressed.
Collapse
|
3
|
Bañuelos Marco B, González R, Ludwikowski B, Lingnau A. Effectiveness of Prenatal Intervention on the Outcome of Diseases That Have a Postnatal Urological Impact. Front Pediatr 2019; 7:118. [PMID: 31001504 PMCID: PMC6454137 DOI: 10.3389/fped.2019.00118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/11/2019] [Indexed: 01/04/2023] Open
Abstract
We reviewed the literature addressing outcomes of fetal intervention of conditions that require post-natal urological management including lower urinary tract obstruction, hydrometrocolpos, congenital adrenal hyperplasia, and myelomeningocele. Despite several decades of fetal intervention for these conditions, benefits remain elusive in part because of the enormous difficulty of conducting prospective randomized studies. In this review, we reached the following conclusions: Prenatal intervention in lower urinary tract obstruction (LUTO) improves survival in the worst cases by improving pulmonary function and it may be advantageous for renal function, particularly in patients with adverse urine parameters.Prenatal treatment of female fetuses at risk of having congenital adrenal hyperplasia (CAH) reduces virilization. Non-invasive fetal DNA analysis allows earlier diagnosis, reducing the risk of treating with dexamethasone males and non-affected fetuses.Fetal treatment of myelomeningocele (MMC) is gaining momentum. Prospective studies including standardized urologic evaluation will determine if the encouraging results reported by some hold on the long term follow-up.
Collapse
Affiliation(s)
| | - Ricardo González
- Department of Urology, Charité Medical University of Berlin, Berlin, Germany
- Pediatric Surgery and Urology, Kinder- und Jugendkrankenhaus AUF DER BULT, Hanover, Germany
| | - Barbara Ludwikowski
- Pediatric Surgery and Urology, Kinder- und Jugendkrankenhaus AUF DER BULT, Hanover, Germany
| | - Anja Lingnau
- Department of Urology, Charité Medical University of Berlin, Berlin, Germany
| |
Collapse
|
4
|
Sharma S, Joshi M, Gupta DK, Abraham M, Mathur P, Mahajan JK, Gangopadhyay AN, Rattan SK, Vora R, Prasad GR, Bhattacharya NC, Samuj R, Rao KLN, Basu AK. Consensus on the Management of Posterior Urethral Valves from Antenatal Period to Puberty. J Indian Assoc Pediatr Surg 2019; 24:4-14. [PMID: 30686881 PMCID: PMC6322183 DOI: 10.4103/jiaps.jiaps_148_18] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The need for successful management of posterior urethral valves always captivates the minds of pediatric surgeons. Its success, however, depends on several factors ranging from prenatal preservation of upper tracts to postoperative pharmacological compliance. Regardless of measures available, some cases do not respond and progress to end stage. The management depends on several issues ranging from age and severity at presentation to long-term follow-up and prevention of secondary renal damage and managing valve bladder syndrome. This article is based on a consensus to the set of questionnaires, prepared by research section of Indian Association of Paediatric Surgeons and discussed by experienced pediatric surgeons based in different institutions in the country. Standard operating procedures for conducting a voiding cystourethrogram and cystoscopy were formulated. Age-wise contrast dosage was calculated for ready reference. Current evidence from literature was also reviewed and included to complete the topic.
Collapse
Affiliation(s)
- Shilpa Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manoj Joshi
- Consultant Pediatric Surgeon, Department of Pediatric Surgery, King Saud Hospital, Uneyzha City, Kingdom of Saudi Arabia
| | - Devendra K Gupta
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mohan Abraham
- Department of Pediatric Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Praveen Mathur
- Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India
| | - J K Mahajan
- Department of Pediatric Surgery, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A N Gangopadhyay
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Simmi K Rattan
- Department of Pediatric Surgery, Maulana Azad Medical College, Delhi, India
| | - Ravindra Vora
- Department of Paediatric Surgery, Paediatric Surgery Centre and PG Institute, Sangli, Maharashtra, India
| | - G Raghavendra Prasad
- Department of Paediatric Surgery, Deccan College of Medical Sciences, Hyderabad, India
| | - N C Bhattacharya
- Department of Paediatric Surgery, Gauhati Medical College, Guwahati, Assam, India
| | - Ram Samuj
- Department of Pediatric Surgery, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K L N Rao
- Department of Pediatric Surgery, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A K Basu
- Consultant Pediatric Surgeon, Institute of Child Health, Kolkata, West Bengal, India
| |
Collapse
|
5
|
Nassr AA, Erfani H, Fisher JE, Ogunleye OK, Espinoza J, Belfort MA, Shamshirsaz AA. Fetal interventional procedures and surgeries: a practical approach. J Perinat Med 2018; 46:701-715. [PMID: 28599395 DOI: 10.1515/jpm-2017-0015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/19/2017] [Indexed: 12/25/2022]
Abstract
Abstract
The identification of congenital birth defects and fetal malformations continues to increase during the antenatal period with improved imaging techniques. Understanding of how to treat specific fetal conditions continues to improve outcomes from these treatment modalities. In an effort to further improvement in this field, we provide a review that begins with a brief background of fetal surgery including the history of fetal surgery, ethics surrounding fetal surgery, and considerations of how to treat the fetus during intervention. A synopsis of the most commonly encountered disease processes treated by fetal intervention/surgery including definitions, treatment modalities, and outcomes following fetal intervention/surgery is then provided. Within the sections describing each disease process, methodology is described that has helped with efficiency and success of procedures performed at our institution.
Collapse
Affiliation(s)
- Ahmed A Nassr
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA.,Women's Health Hospital, Assiut University, Assiut, Egypt
| | - Hadi Erfani
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - James E Fisher
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - Oluseyi K Ogunleye
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - Jimmy Espinoza
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - Michael A Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - Alireza A Shamshirsaz
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, 6651 Main Street, Houston, TX 77030, USA,
| |
Collapse
|
6
|
Magawa S, Tanaka H, Nii M, Maki S, Kamimoto Y, Ikeda T. In utero spontaneous bladder rupture in a fetus with posterior urethral valve: A case report of prenatal diagnosis and management. J Obstet Gynaecol Res 2018; 44:1318-1321. [PMID: 29673009 DOI: 10.1111/jog.13646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 02/21/2018] [Indexed: 11/28/2022]
Abstract
Posterior urethral valve (PUV) rarely causes bladder rupture. We experienced hydronephrosis due to ureteral obstruction after the natural repair of a ruptured bladder in a fetus with PUV. Fetal ascites and oligohydramnios were diagnosed at 26 weeks' gestational age. While we followed up with ultrasonography, we regularly removed the fetal ascites via abdominal puncture, injecting warm saline instead of amniotic fluid. At 35 weeks' gestational age, the infant was diagnosed with severe bilateral hydronephrosis, absent of ascites and oligohydramnios. Therefore, a Caesarean section was performed. After birth, the infant was diagnosed with hydronephrosis due to ureteral obstruction after the natural repair of a ruptured bladder associated with PUV. Thus, a ruptured bladder in a fetus with PUV that has naturally repaired should be closely monitored via ultrasonography for hydronephrosis due to ureteral obstruction.
Collapse
Affiliation(s)
- Shoichi Magawa
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan
| | - Masafumi Nii
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan
| | - Shintaro Maki
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan
| | - Yuki Kamimoto
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan
| |
Collapse
|
7
|
Nassr AA, Shazly SAM, Abdelmagied AM, Araujo Júnior E, Tonni G, Kilby MD, Ruano R. Effectiveness of vesicoamniotic shunt in fetuses with congenital lower urinary tract obstruction: an updated systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:696-703. [PMID: 27270578 DOI: 10.1002/uog.15988] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/26/2016] [Accepted: 05/31/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To evaluate the effect on perinatal and postnatal survival of vesicoamniotic shunt (VAS) as treatment for fetal lower urinary tract obstruction (LUTO). METHODS An electronic search of Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews and Scopus using relevant search terms was conducted from inception to June 2015 to identify studies comparing outcomes of VAS vs conservative management for treatment of LUTO. Cohort studies and clinical trials were considered eligible. Single-arm studies and studies that did not report survival were excluded. Sample size and language were not criteria for exclusion. Two reviewers extracted independently data in a standardized form, including study characteristics and results. Primary outcomes were perinatal and postnatal survival. Secondary outcome was postnatal renal function. Data on fetal survival were expressed as odds ratio (OR) and 95% CI. RESULTS Of the 423 abstracts retrieved, nine studies were eligible for inclusion. These studies included 112 fetuses treated with VAS and 134 that were managed conservatively. There was heterogeneity in study design. Although the data demonstrated a difference in effect estimates between the study arms in terms of perinatal survival (OR, 2.54 (95% CI, 1.14-5.67)), there was no difference in 6-12-month survival (OR, 1.77 (95% CI, 0.25-12.71)) or 2-year survival (OR, 1.81 (95% CI, 0.09-38.03)). In addition, there was no difference in effect on postnatal renal function between fetuses that underwent intervention and those that did not (OR, 2.09 (95% CI, 0.74-5.94)). CONCLUSIONS Available data seem to support an advantage for perinatal survival in fetuses treated with VAS compared with conservative management. However, 1-2-year survival and outcome of renal function after VAS procedure remain uncertain. Further studies are necessary to evaluate the effectiveness of fetal intervention for LUTO based on different severity of the disease, due to the very low quality of the studies according to GRADE guidelines. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- A A Nassr
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Women's Health Hospital, Assiut University Hospitals, Assiut, Egypt
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - S A M Shazly
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Women's Health Hospital, Assiut University Hospitals, Assiut, Egypt
| | - A M Abdelmagied
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Women's Health Hospital, Assiut University Hospitals, Assiut, Egypt
| | - E Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo, São Paulo, Brazil
| | - G Tonni
- Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, AUSL Reggio Emilia, Reggio Emilia, Italy
| | - M D Kilby
- Centre for Women's and Children's Health, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - R Ruano
- Mayo Clinic Fetal Diagnostic and Therapeutic Center, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
8
|
Chitrit Y, Bourdon M, Korb D, Grapin-Dagorno C, Joinau-Zoulovits F, Vuillard E, Paye-Jaouen A, Peycelon M, Belarbi N, Delezoide AL, Schmitz T, El Ghoneimi A, Sibony O, Oury JF. Posterior urethral valves and vesicoureteral reflux: can prenatal ultrasonography distinguish between these two conditions in male fetuses? Prenat Diagn 2016; 36:831-7. [DOI: 10.1002/pd.4868] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 06/20/2016] [Accepted: 06/26/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Yvon Chitrit
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | - Mathilde Bourdon
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | - Diane Korb
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | | | | | - Edith Vuillard
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | - Annabel Paye-Jaouen
- Department of Pediatric Urology and Surgery; Hôpital Robert Debré AP-HP; Paris France
| | - Matthieu Peycelon
- Department of Pediatric Urology and Surgery; Hôpital Robert Debré AP-HP; Paris France
| | - Nadia Belarbi
- Department of Pediatric Imaging; Hôpital Robert Debré AP-HP; Paris France
| | - Anne-Lyse Delezoide
- Department of Developmental Biology; Hôpital Robert Debré AP-HP; Paris France
| | - Thomas Schmitz
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | - Alaa El Ghoneimi
- Department of Pediatric Urology and Surgery; Hôpital Robert Debré AP-HP; Paris France
| | - Olivier Sibony
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | - Jean-François Oury
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| |
Collapse
|
9
|
Calvo-Garcia MA. Imaging Evaluation of Fetal Megacystis: How Can Magnetic Resonance Imaging Help? Semin Ultrasound CT MR 2015; 36:537-49. [PMID: 26614135 DOI: 10.1053/j.sult.2015.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Evaluation of the kidneys, bladder, and amniotic fluid volume forms part of any standard obstetrical ultrasound. When a fetal genitourinary anomaly is suspected, a more detailed evaluation is necessary. This detailed imaging can be challenging in the setting of decreased or absent amniotic fluid or large maternal body habitus, and in complex malformations. In these situations, magnetic resonance imaging can help to better define the fetal anatomy and provide a more confident and specific prenatal diagnosis.
Collapse
Affiliation(s)
- Maria A Calvo-Garcia
- Department of Radiology, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH.
| |
Collapse
|
10
|
Cavoretto P, Lesma A, Spagnolo D, Valsecchi L, Negretto A, Candiani M. Prenatal sonographic monitoring of idiopathic megacystis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:116-118. [PMID: 21953421 DOI: 10.1002/jcu.20885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 08/16/2011] [Indexed: 05/31/2023]
Abstract
This case report is of a female fetus diagnosed with severe idiopathic megacystis at 21 weeks of pregnancy. Sonographic monitoring demonstrated normal amniotic fluid volume and renal structures, absence of hydronephrosis, ureteral dilation, and associated abnormalities. Conservative management was chosen with postnatal confirmation of diagnosis. The neonate presented seizures, and subsequent magnetic resonance imaging demonstrated transverse sinus thrombosis with adjacent ischemic damage. At present, the infant is 2 years old, and she is thriving normally and maintains urinary continence with spontaneous voidings.
Collapse
Affiliation(s)
- Paolo Cavoretto
- Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | | | | |
Collapse
|
11
|
|
12
|
Bracero LA, Seybold DJ, Koike J. Prenatal Diagnosis of Spontaneous Bladder Rupture in a Female Fetus. Urology 2011; 77:1474-6. [DOI: 10.1016/j.urology.2010.07.500] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 07/27/2010] [Accepted: 07/29/2010] [Indexed: 11/17/2022]
|
13
|
Bernardes LS, Aksnes G, Saada J, Masse V, Elie C, Dumez Y, Lortat-Jacob SL, Benachi A. Keyhole sign: how specific is it for the diagnosis of posterior urethral valves? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:419-423. [PMID: 19642115 DOI: 10.1002/uog.6413] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Posterior urethral valves (PUV) are the most common cause of renal impairment in boys during early childhood. Although antenatal suspicion of this pathology has become quite common in recent years, prenatal diagnosis remains challenging. The aim of this study was to evaluate the predictive value of different ultrasound criteria currently used to diagnose PUV. METHODS We reviewed the antenatal and postnatal files of 54 male patients referred to our center from 2000 to 2006 after detection of fetal bilateral hydronephrosis. The following ultrasound criteria were evaluated in relation to the postnatal diagnosis of PUV: amniotic fluid volume, bladder wall thickness, bladder dilatation and the presence of the 'keyhole sign'. RESULTS Forty-two fetuses (77.8%) were suspected to have PUV on prenatal examination. Out of these, 29 (69.0%) had PUV confirmed postnatally. The sensitivity and specificity of the antenatal diagnosis of PUV were 94% and 43%, respectively. Increased bladder wall thickness and bladder dilatation were highly associated with the diagnosis of PUV (P < 0.001). However, a thick-walled bladder was observed in 39.1% and a dilated bladder in 47.8% of the infants with a postnatal diagnosis other than PUV. The presence of the keyhole sign was not found to predict a diagnosis of PUV (P = 0.27). CONCLUSION In this series the use of classical prenatal ultrasound signs to diagnose PUV showed high sensitivity but low specificity. The best diagnostic indicators were increased bladder wall thickness and dilatation of the bladder. The keyhole sign was not found to be a reliable predictor of PUV.
Collapse
Affiliation(s)
- L S Bernardes
- Maternité, Université Paris Descartes, Faculté de Médecine, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Singh S, Robinson M, Nahi F, Coley B, Robinson ML, Bates CM, Kornacker K, McHugh KM. Identification of a Unique Transgenic Mouse Line That Develops Megabladder, Obstructive Uropathy, and Renal Dysfunction. J Am Soc Nephrol 2007; 18:461-71. [PMID: 17202422 DOI: 10.1681/asn.2006040405] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Urinary tract malformations, obstructive uropathy, and hypoplasia/dysplasia are extremely important in terms of pediatric health care costs, with end-stage renal failure in children estimated to cost >$15 billion annually in the United States alone. Even so, little is known regarding the mechanisms that control these processes. Identified was a unique mutant mouse model that develops in utero megabladder, resulting in variable hydroureteronephrosis and chronic renal failure secondary to obstructive uropathy. These animals, designated mgb for megabladder, possess a primary defect in bladder smooth muscle development that is apparent by embryonic day 15. The mgb mouse represents an excellent model for the study of normal and pathogenic bladder development, including the postnatal progression of chronic renal failure that results from the development of in utero obstructive uropathy.
Collapse
Affiliation(s)
- Sunita Singh
- Columbus Children's Research Institute, 700 Children's Drive, Suite WA 2014, Columbus, OH 43205, USA
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Jung E, Won HS, Shim JY, Lee PR, Kim A, Kim KS. Successful outcome following prenatal intervention in a female fetus with bladder outlet obstruction. Prenat Diagn 2005; 25:1107-10. [PMID: 16231298 DOI: 10.1002/pd.1285] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Bladder outlet obstructions are a diverse and heterogeneous group of developmental abnormalities that generally involve obstruction of the proximal urethra in the male fetus. Indications for prenatal intervention are few and are usually restricted to the male fetus because bladder outlet obstruction in female fetuses is usually caused by complex cloacal development anomalies. We report on a female fetus with an enlarged bladder and a dilated proximal urethra (known as typical keyhole sign). A vesicoamniotic shunt was performed despite non-reassuring prognostic factors, but the procedure resulted in a successful outcome. We propose that in selected cases of bladder outlet obstruction, fetal intervention should be considered even when the fetus is female.
Collapse
Affiliation(s)
- Eui Jung
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
16
|
Miguelez J, Bunduki V, Yoshizaki CT, Sadek LDSR, Koch V, Peralta CFA, Zugaib M. Fetal obstructive uropathy: is urine sampling useful for prenatal counselling? Prenat Diagn 2005; 26:81-4. [PMID: 16374901 DOI: 10.1002/pd.1360] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To evaluate whether fetal urinary sodium and chloride provide clinically useful information in addition to ultrasound in bilateral obstructive uropathy. METHODS Sonographic features and urinary concentrations of sodium and chloride were evaluated in fetuses with bilateral obstructive uropathy. After a minimum of 12 months of postnatal follow-up, cases that developed increased serum creatinine (greater than 50 micromol/L) were compared with those that did not. RESULTS Of the cases studied, 16/35 died perinatally, all showing anamnios and markedly elevated urinary electrolytes. Of the survivors, ten maintained normal postnatal serum creatinine, whereas nine did not. The frequency of reduced amniotic fluid/olygohydramnios was higher in cases that developed increased serum creatinine (four out of nine) than in those that did not (nil). Sodium above the 95th percentile was 100% specific and 44% sensitive to predict an increased serum creatinine during early infancy, while chloride above the 95th percentile was 70% specific and 56% sensitive. All seven cases in which urinary sodium was elevated and/or amniotic fluid volume was reduced developed renal failure. CONCLUSION Urine sampling slightly improved renal function prediction, but this must be balanced against its fetal risks.
Collapse
Affiliation(s)
- Javier Miguelez
- Department of Obstetrics and Gynecology, University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil
| | | | | | | | | | | | | |
Collapse
|