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Diagnosis, Management, and Therapy of Fetal Ovarian Cysts Detected by Prenatal Ultrasonography: A Report of 36 Cases and Literature Review. Diagnostics (Basel) 2021; 11:diagnostics11122224. [PMID: 34943461 PMCID: PMC8700714 DOI: 10.3390/diagnostics11122224] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Fetal ovarian cysts are the most frequently diagnosed intra-abdominal cysts; however, the evidence for perinatal management remains controversial. METHODS We retrospectively reviewed cases of fetal ovarian cysts diagnosed by prenatal ultrasonography at our institution between January 2010 and January 2020. The following were investigated: gestational age at diagnosis, cyst size, appearance, prenatal ultrasound findings, and postnatal outcomes. Prior to 2018, expectant management was applied in all cases; after 2018, in utero aspiration (IUA) of simple cysts ≥40 mm was performed. RESULTS We diagnosed 29 and seven simple and complex cysts, respectively. Fourteen patients had simple cysts with a maximum diameter <40 mm, and two of them progressed to complex cysts during follow-up; however, when the diameter was limited to <35 mm, no cases showed progression to complex cyst. Fifteen of the simple cysts were ≥40 mm; three progressed to complex cysts, and two of them were confirmed to be ovarian necrosis. In four patients who underwent IUA, the ovaries could be preserved. CONCLUSIONS IUA is a promising therapy for preserving ovaries with simple cysts ≥40 mm in diameter; however, the indications for fetal surgery and the appropriate timing of intervention require further study.
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Rosenblatt J, Dreux S, Spaggiari E, Morin C, Allaf B, Valat AS, Halim D, Oury JF, Muller F. Prenatal diagnosis of megacystis microcolon intestinal hypoperistalsis syndrome by biochemical analysis of fetal urine. Prenat Diagn 2018; 38:585-590. [PMID: 29752823 DOI: 10.1002/pd.5283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/18/2018] [Accepted: 05/01/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The objective of the study is to determine a model of fetal urine biochemical markers to differentiate megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) from other megacystis. METHOD This is a retrospective study of biochemical analysis of fetal urine in patients who presented prenatally with megacystis. We studied β2-microglobulin, sodium, calcium, and phosphorus. Twenty-six patients subsequently diagnosed with MMIHS were compared with 2 control groups: one of end-stage renal failure (64 fetuses) and the second of "good" postnatal renal function (control group, 64 fetuses). RESULTS Mean fetal urine β2-microglobulin was significantly higher (P < .001) in end-stage renal failure (15.7 mg/L) than in MMIHS (2.2 mg/L) and the control group (3.2 mg/L). Fetal urine profiles differed significantly (P < .001) between MMIHS and the control group: median sodium 46.5 and 51 mmol/L, median calcium 1.12 and 0.73 mmol/L, and median phosphorus 0.03 and 0.15 mmol/L respectively. Fetal urinary ionic index [ratio: calcium / (phosphorus × sodium)] gave an area under the ROC curve of 0.86, at 54% sensitivity and 97% specificity, with correct classification in 84% of cases. We defined a nomogram to obtain a probability for MMIHS. CONCLUSION Fetal urinalysis can be helpful in prenatal differentiation of MMIHS from posterior urethral valves with good postnatal renal function.
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Affiliation(s)
- Jonathan Rosenblatt
- Gynecologie-Obstétrique, Hôpital Universitaire Robert Debré, APHP, Paris, France
| | - Sophie Dreux
- Biochimie-Hormonologie, Hôpital Universitaire Robert Debré, APHP, Paris, France
| | | | - Cécile Morin
- Gynecologie-Obstétrique, Hôpital Universitaire Robert Debré, APHP, Paris, France
| | - Bichr Allaf
- Biochimie-Hormonologie, Hôpital Universitaire Robert Debré, APHP, Paris, France
| | - Anne Sylvie Valat
- Gynécologie-Obstétrique, Centre Hospitalier Lens, CPDPN, Lille, France
| | - Danny Halim
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jean-François Oury
- Gynecologie-Obstétrique, Hôpital Universitaire Robert Debré, APHP, Paris, France
| | - Françoise Muller
- Biochimie-Hormonologie, Hôpital Universitaire Robert Debré, APHP, Paris, France
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Spaggiari E, Stirnemann JJ, Benedetti S, Dreux S, Salomon LJ, Blanc T, Rosenblatt J, Favre R, Ville Y, Muller F. Comparison of biochemical analysis of fetal serum and fetal urine in the prediction of postnatal renal outcome in lower urinary tract obstruction. Prenat Diagn 2018; 38:555-560. [PMID: 29644715 DOI: 10.1002/pd.5263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/18/2018] [Accepted: 04/02/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To compare the prognostic value of fetal serum biochemistry and fetal urine biochemistry in predicting renal outcome in lower urinary tract obstruction (LUTO). METHODS We retrospectively studied renal outcome following a prenatal diagnosis of LUTO in cases for which both fetal blood and fetal urine were sampled. We classified the renal outcome as either "favorable," when postnatal renal function was normal, or "adverse," in the case of postnatal chronic renal failure or when renal histological lesions were present at autopsy in the case of termination of pregnancy. A prognostic model was constructed for urine and serum separately. β2-Microglobulin was the only remaining independent predictor in fetal urine. β2-Microglobulin in serum and urine were compared by using receiver operating characteristic curves. RESULTS In the 50 cases included, the rate of adverse outcome was 34 of 50(68%): autopsy confirmed severity of renal disease in all 27 cases who underwent termination of pregnancy, and among the 23 live born children, 7 developed renal failure. Fetal serum and urine markers were all significantly associated with renal outcome (P < .01). The receiver operating characteristic curves for fetal serum and fetal urinary β2-microglobulin were similar (area under the curve = 0.908 versus 0.909, P = .96). CONCLUSION Fetal serum biochemistry and fetal urine biochemistry are of similar prognostic value in predicting postnatal renal outcome in fetuses with LUTO.
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Affiliation(s)
- Emmanuel Spaggiari
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Julien J Stirnemann
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - Sara Benedetti
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Sophie Dreux
- Department of Biochemistry and Hormonology, Robert Debré Hospital, AP-HP, Paris, France
| | - Laurent J Salomon
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - Jonathan Rosenblatt
- Department of Obstetrics and Gynecology, Robert Debré Hospital, AP-HP, Paris, France
| | - Romain Favre
- Obstetrics and Gynecology Department, Hautepierre and CMCO Hospital, Strasbourg, France
| | - Yves Ville
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - Françoise Muller
- Department of Biochemistry and Hormonology, Robert Debré Hospital, AP-HP, Paris, France
- University Versailles Saint-Quentin, Versailles, France
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Bascietto F, Liberati M, Marrone L, Khalil A, Pagani G, Gustapane S, Leombroni M, Buca D, Flacco ME, Rizzo G, Acharya G, Manzoli L, D'Antonio F. Outcome of fetal ovarian cysts diagnosed on prenatal ultrasound examination: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:20-31. [PMID: 27325566 DOI: 10.1002/uog.16002] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To explore the outcome of fetuses with a prenatal diagnosis of ovarian cyst. METHODS The electronic databases MEDLINE and EMBASE were searched using keywords and word variants for 'ovarian cysts', 'ultrasound' and 'outcome'. The following outcomes in fetuses with a prenatal diagnosis of ovarian cyst were explored: resolution of the cyst, change of ultrasound pattern of the cyst, occurrence of ovarian torsion and intracystic hemorrhage, need for postnatal surgery, need for oophorectomy, accuracy of prenatal ultrasound examination in correctly identifying ovarian cyst, type of ovarian cyst at histopathological analysis and intrauterine treatment. Meta-analyses using individual data random-effects logistic regression and meta-analyses of proportions were performed. Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale. RESULTS Thirty-four studies (954 fetuses) were included. In 53.8% (95% CI, 46.0-61.5%) of cases for which resolution of the cyst was evaluated (784 fetuses), the cyst regressed either during pregnancy or after birth. The likelihood of resolution was significantly lower in complex vs simple cysts (odds ratio (OR), 0.15 (95% CI, 0.10-0.23)) and in cysts measuring ≥ 40 mm vs < 40 mm (OR, 0.03 (95% CI, 0.01-0.06)). Change in ultrasound pattern of the cyst was associated with an increased risk of ovarian loss (surgical removal or autoamputation) (pooled proportion, 57.7% (95% CI, 42.9-71.8%)). The risk of ovarian torsion was significantly higher for cysts measuring ≥ 40 mm compared with < 40 mm (OR, 30.8 (95% CI, 8.6-110.0)). The likelihood of having postnatal surgery was higher in patients with cysts ≥ 40 mm compared with < 40 mm (OR, 64.4 (95% CI, 23.6-175.0)) and in complex compared with simple cysts, irrespective of cyst size (OR, 14.6 (95% CI, 8.5-24.8)). In cases undergoing prenatal aspiration of the cyst, rate of recurrence was 37.9% (95% CI, 14.8-64.3%), ovarian torsion and intracystic hemorrhage were diagnosed after birth in 10.8% (95% CI, 4.4-19.7%) and 12.8% (95% CI, 3.8-26.0%), respectively, and 21.8% (95% CI, 0.9-40.0%) had surgery after birth. CONCLUSION Size and ultrasound appearance are the major determinants of perinatal outcome in fetuses with ovarian cysts. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F Bascietto
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - M Liberati
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - L Marrone
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - A Khalil
- Fetal Medicine Unit, St George's University of London and St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - G Pagani
- Department of Obstetrics and Gynaecology, Fondazione Poliambulanza, Brescia, Italy
| | - S Gustapane
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - M Leombroni
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - D Buca
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - M E Flacco
- Department of Medicine and Aging Sciences, University of Chieti-Pescara, Chieti, Italy
| | - G Rizzo
- Department of Obstetrics and Gynaecology, University of Rome, Rome, Italy
| | - G Acharya
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynaecology, University Hospital of Northern Norway, Tromsø, Norway
| | - L Manzoli
- Department of Medicine and Aging Sciences, University of Chieti-Pescara, Chieti, Italy
| | - F D'Antonio
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynaecology, University Hospital of Northern Norway, Tromsø, Norway
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Abdennadher W, Chalouhi G, Dreux S, Rosenblatt J, Favre R, Guimiot F, Salomon LJ, Oury JF, Ville Y, Muller F. Fetal urine biochemistry at 13-23 weeks of gestation in lower urinary tract obstruction: criteria for in-utero treatment. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:306-311. [PMID: 25412852 DOI: 10.1002/uog.14734] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 11/12/2014] [Accepted: 11/12/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To assess the value of fetal urine biochemistry before 23 weeks of gestation in cases of lower urinary tract obstruction (LUTO) to refine prognosis and to select potential candidates for in-utero intervention. METHODS This was a retrospective study including 72 cases of LUTO with fetal urine sampled before 23 weeks and assayed for total protein, β-2-microglobulin, sodium, chloride, calcium, phosphorus, glucose and gamma-glutamyl transpeptidase (GGTP). Two groups were defined according to renal outcome: 1) bilateral renal dysplasia on histological examination or renal failure at birth; 2) normal postnatal renal function or histologically normal appearance of the kidneys. Correlations between fetal urinary biochemical markers and postnatal renal function were studied. RESULTS LUTO was isolated in 56/72 (77.8%) cases and was associated with other malformations in 16/72 (22.2%) cases. High GGTP levels (236 IU/L vs 5 IU/L; P < 0.0001) were observed in fetal urine in the five cases of urodigestive fistula. A significant difference between outcome groups was observed for β-2-microglobulin (P = 0.0017), sodium (P = 0.0008), chloride (P = 0.0028) and calcium (P = 0.0092) but not for protein, glucose or phosphorus. Sensitivity and specificity in defining a poor renal prognosis were 80.6% and 89% for β-2-microglobulin, 61.3% and 100% for sodium and 64.5% and 100% for calcium, respectively. CONCLUSIONS Fetal urinalysis before 23 weeks of gestation allowed distinction between three groups: 1) fetuses with normal urine biochemistry for which fetal therapy should be discussed; 2) fetuses with abnormal urine biochemistry for which prognosis for renal outcome is poor and for which the benefit of fetal therapy is likely to be compromised; 3) fetuses with urodigestive fistula.
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Affiliation(s)
- W Abdennadher
- Department of Obstetrics and Gynaecology, Hôpital Necker Enfants Malades, APHP, Paris, France
| | - G Chalouhi
- Department of Obstetrics and Gynaecology, Hôpital Necker Enfants Malades, APHP, Paris, France
| | - S Dreux
- Department of Biochemistry, Hôpital Robert Debré, APHP, Paris, France
| | - J Rosenblatt
- Department of Obstetrics and Gynaecology, Hôpital Robert Debré, APHP, Paris, France
| | - R Favre
- Department of Obstetrics and Gynaecology, CMCO, Schiltigheim, France
| | - F Guimiot
- Department of Developmental Biology, Hôpital Robert Debré, APHP, Paris, France
| | - L J Salomon
- Department of Obstetrics and Gynaecology, Hôpital Necker Enfants Malades, APHP, Paris, France
| | - J F Oury
- Department of Obstetrics and Gynaecology, Hôpital Robert Debré, APHP, Paris, France
| | - Y Ville
- Department of Obstetrics and Gynaecology, Hôpital Necker Enfants Malades, APHP, Paris, France
| | - F Muller
- Department of Biochemistry, Hôpital Robert Debré, APHP, Paris, France
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Desseauve D, Voluménie JL, Gueneret M, Colombani JF, Schaub B, Muller F. [Contribution of the biochemical study of amniotic and cystic fluids for prenatal diagnosis of urogenital sinus]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2015; 43:398-400. [PMID: 25890506 DOI: 10.1016/j.gyobfe.2015.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 03/11/2015] [Indexed: 11/25/2022]
Affiliation(s)
- D Desseauve
- Université de Poitiers, CHU de Poitiers, 86021 Poitiers cedex, France; Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, 86021 Poitiers cedex, France.
| | - J-L Voluménie
- Service de gynécologie-obstétrique, maison de la femme, de la mère et de l'enfant, CHU de Fort-de-France, 97261 Fort-de-France cedex, Martinique
| | - M Gueneret
- Service de gynécologie-obstétrique, maison de la femme, de la mère et de l'enfant, CHU de Fort-de-France, 97261 Fort-de-France cedex, Martinique
| | - J-F Colombani
- Service de chirurgie pédiatrique, maison de la femme, de la mère et de l'enfant, CHU de Fort-de-France, 97261 Fort-de-France cedex, Martinique
| | - B Schaub
- Service de gynécologie-obstétrique, maison de la femme, de la mère et de l'enfant, CHU de Fort-de-France, 97261 Fort-de-France cedex, Martinique
| | - F Muller
- Biochimie hormonologie, hôpital Robert-Debré, AP-HP, 75019 Paris, France
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Chitrit Y, Vuillard E, Khung S, Belarbi N, Guimiot F, Muller F, Ghoneimi AE, Oury JF. Cloaca in discordant monoamniotic twins: prenatal diagnosis and consequence for fetal lung development. AJP Rep 2014; 4:33-6. [PMID: 25032057 PMCID: PMC4078163 DOI: 10.1055/s-0034-1370351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/30/2013] [Indexed: 11/04/2022] Open
Abstract
Objective Describe a case of cloaca prenatally diagnosed in one of a set of monoamniotic twins. Study Design Retrospective review of a case. Results Cloaca is one of the most complex and severe degrees of anorectal malformations in girls. We present a discordant cloaca in monoamniotic twins. Fetal ultrasound showed a female fetus with a pelvic midline cystic mass, a phallus-like structure, a probable anorectal atresia with absence of anal dimple and a flat perineum, and renal anomalies. The diagnosis was confirmed by fetal magnetic resonance imaging postnatally. Conclusions The rarity of the malformation in a monoamniotic pregnancy, the difficulties of prenatal diagnosis, the pathogenic assumptions, and the consequences of adequate amniotic fluid for fetal lung development are discussed.
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Affiliation(s)
- Yvon Chitrit
- Department of Obstetrics and Gynecology, Robert Debré Hospital-AP-HP, Paris, France
| | - Edith Vuillard
- Department of Obstetrics and Gynecology, Robert Debré Hospital-AP-HP, Paris, France
| | - Sunavy Khung
- Department of Developmental Biology, Robert Debré Hospital-AP-HP, Paris, France
| | - Nadia Belarbi
- Department of Pediatric Imaging, Robert Debré Hospital-AP-HP, Paris, France
| | - Fabien Guimiot
- Department of Developmental Biology, Robert Debré Hospital-AP-HP, Paris, France
| | - Francoise Muller
- Laboratory of Biochemistry and Hormonology, Robert Debré Hospital-AP-HP, Paris, France
| | - Alaa El Ghoneimi
- Department of Pediatric Urology and Surgery, Robert Debré Hospital-AP-HP, Paris, France
| | - Jean Francois Oury
- Department of Obstetrics and Gynecology, Robert Debré Hospital-AP-HP, Paris, France
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Bornes M, Spaggiari E, Schmitz T, Dreux S, Czerkiewicz I, Delezoide AL, El-Ghoneimi A, Oury JF, Muller F. Outcome and etiologies of fetal megacystis according to the gestational age at diagnosis. Prenat Diagn 2013; 33:1162-6. [PMID: 23939878 DOI: 10.1002/pd.4215] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 07/28/2013] [Accepted: 08/09/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the gestational age-specific outcomes and the different etiologies of megacystis diagnosed at screening ultrasound. METHODS A retrospective single-center study was conducted between 1989 and 2009. We identified all consecutive cases of megacystis prenatally diagnosed during routine ultrasound screening. Outcome, final diagnosis, and renal function were recorded. RESULTS Eighty-four patients were included. An isolated lower urinary tract obstruction was observed in 38/84 (45.2%), ureterovesical reflux in 9/84 (10.7%), an associated congenital abnormality in 32/84 (38.1%) and a normal bladder in 5/84 (6%). Increased gestational age at diagnosis was correlated with an increased rate of live born children (P < 0.01). No cases of megacystis diagnosed in the first trimester were born alive. When diagnosis of posterior urethral valves (PUV) was made in the third trimester, the ultimate survival rate was 11/13 (84.6%) compared with 3/12 (25%) for a diagnosis made in the second trimester (P = 0.02). CONCLUSION Lower urinary tract obstruction is the main etiology of megacystis. Megacystis can also be part of more complex malformations. Outcome of megacystis detected in the first trimester is poor. PUV detected in the third trimester had a better overall survival rate than PUV detected in the second trimester.
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Affiliation(s)
- Marie Bornes
- Gynecology and Obstetrics, AP-HP, Robert Debré Hospital, Paris, France; Gynecology and Obstetrics, AP-HP, Tenon Hospital, Paris, France
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