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Mandaletti M, Cerchia E, Ruggiero E, Teruzzi E, Bastonero S, Pertusio A, Della Corte M, Sciarrone A, Gerocarni Nappo S. Obstructive or non-obstructive megacystis: a prenatal dilemma. Front Pediatr 2024; 12:1379267. [PMID: 39015208 PMCID: PMC11249744 DOI: 10.3389/fped.2024.1379267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 06/03/2024] [Indexed: 07/18/2024] Open
Abstract
Introduction Diagnosis of prenatal megacystis has a significant impact on the pregnancy, as it can have severe adverse effects on fetal and neonatal survival and renal and pulmonary function. The study aims to investigate the natural history of fetal megacystis, to try to differentiate in utero congenital lower urinary tract obstruction (LUTO) from non-obstructive megacystis, and, possibly, to predict postnatal outcome. Materials and methods A retrospective single-center observational study was conducted from July 2015 to November 2023. The inclusion criteria were a longitudinal bladder diameter (LBD) >7 mm in the first trimester or an overdistended/thickened-walled bladder failing to empty in the second and third trimesters. Close ultrasound follow-up, multidisciplinary prenatal counseling, and invasive and non-invasive genetic tests were offered. Informed consent for fetal autopsy was obtained in cases of termination of pregnancy or intrauterine fetal demise (IUFD). Following birth, neonates were followed up at the same center. Patients were stratified based on diagnosis: LUTO (G1), urogenital anomalies other than LUTO ("non-LUTO") (G2), and normal urinary tract (G3). Results This study included 27 fetuses, of whom 26 were males. Megacystis was diagnosed during the second and third trimesters in 92% of the fetuses. Of the 27 fetuses, 3 (11.1%) underwent an abortion, and 1 had IUFD. Twenty-three newborns were live births (85%) at a mean gestational age (GA) of 34 ± 2 weeks. Two patients (neonates) died postnatally due to severe associated malformations. Several prenatal parameters were evaluated to differentiate patients with LUTO from those with non-LUTO, including the severity of upper tract dilatation, keyhole sign, oligohydramnios, LBD, and GA at diagnosis. However, none proved predictive of the postnatal diagnosis. Similarly, none of the prenatal parameters evaluated were predictive of postnatal renal function. Discussion The diagnosis of megacystis in the second and third trimesters was associated with live births in up to 85% of cases, with LUTO identified as the main cause of fetal megacystis. This potentially more favorable outcome, compared to the majority reported in literature, should be taken into account in prenatal counseling. Megacystis is an often misinterpreted antennal sign that may hide a wide range of diagnoses with different prognoses, beyond an increased risk of adverse renal and respiratory outcomes.
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Affiliation(s)
- Martina Mandaletti
- Pediatric Urology Unit, Department of Public Health and Pediatric Sciences, Regina Margherita Children’s Hospital, Turin, Italy
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Elisa Cerchia
- Pediatric Urology Unit, Department of Public Health and Pediatric Sciences, Regina Margherita Children’s Hospital, Turin, Italy
| | - Elena Ruggiero
- Pediatric Urology Unit, Department of Public Health and Pediatric Sciences, Regina Margherita Children’s Hospital, Turin, Italy
- Pediatric Surgery Unit, Department of Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Elisabetta Teruzzi
- Pediatric Urology Unit, Department of Public Health and Pediatric Sciences, Regina Margherita Children’s Hospital, Turin, Italy
| | - Simona Bastonero
- Obstetrics-Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and Gynecology, AOU Città Della Salute e Della Scienza, Turin, Italy
| | - Annasilvia Pertusio
- Obstetrics-Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and Gynecology, AOU Città Della Salute e Della Scienza, Turin, Italy
| | - Marcello Della Corte
- Pediatric Urology Unit, Department of Public Health and Pediatric Sciences, Regina Margherita Children’s Hospital, Turin, Italy
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Andrea Sciarrone
- Obstetrics-Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and Gynecology, AOU Città Della Salute e Della Scienza, Turin, Italy
| | - Simona Gerocarni Nappo
- Pediatric Urology Unit, Department of Public Health and Pediatric Sciences, Regina Margherita Children’s Hospital, Turin, Italy
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Sánchez-Prieto M, Perdomo L, Cortés B, Rodríguez I, Prats P, Rodríguez-Melcón A, Barri-Soldevila P, Serra B, Albaigés G. Fetal Megacystis: Associated Structural Abnormalities and Obstetric Outcomes. Fetal Pediatr Pathol 2022; 42:394-399. [PMID: 36582017 DOI: 10.1080/15513815.2022.2158052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose: We evaluated the obstetrical outcomes, ultrasonographic characteristics, and final diagnosis in pregnancies with fetal megacystis (FM). Methods: We evaluated the obstetrical outcomes and associated structural abnormalities of fetuses with FM detected between FM between 2000 and 2021. Results: 17 FM were diagnosed, 16 had follow up. 16 were early megacystis. 14/16 (87.5%) of pregnancies were terminated, 1/16 (6.25%) resulted in intrauterine death, and 1/16 (6.25%) survived. FM was associated with 13 other abnormal sonographic findings in 12/16 (75%) pregnancies. The most common associated ultrasound abnormality was umbilical cord cyst in 3/16 (18.75%). Recognized etiologies included posterior urethral valves (2), trisomy 18 (2), trisomy 13 (1), Prune Belly syndrome (1), and Megacystis-Microcolon-Hypoperistalsis syndrome (1). Conclusion: Most FM are detected in the 2nd trimester, most are electively terminated, are associated with other ultrasonic abnormalities in 75%, most commonly umbilical cord cyst, and have an identifiable cause in 44%.
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Affiliation(s)
- Manuel Sánchez-Prieto
- Department of Obstetrics and Gynecology, Instituto Universitario Dexeus, Barcelona, Spain
| | - Laura Perdomo
- Department of Obstetrics and Gynecology, Instituto Universitario Dexeus, Barcelona, Spain
| | - Berta Cortés
- Department of Obstetrics and Gynecology, Instituto Universitario Dexeus, Barcelona, Spain
| | - Ignacio Rodríguez
- Department of Obstetrics and Gynecology, Instituto Universitario Dexeus, Barcelona, Spain
| | - Pilar Prats
- Department of Obstetrics and Gynecology, Instituto Universitario Dexeus, Barcelona, Spain
| | | | - Pere Barri-Soldevila
- Department of Obstetrics and Gynecology, Instituto Universitario Dexeus, Barcelona, Spain
| | - Bernat Serra
- Department of Obstetrics and Gynecology, Instituto Universitario Dexeus, Barcelona, Spain
| | - Gerard Albaigés
- Department of Obstetrics and Gynecology, Instituto Universitario Dexeus, Barcelona, Spain
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Farrugia MK. Vesico-amniotic shunt insertion prior to the completion of 16 weeks results in improved preservation of renal function in surviving fetuses with isolated severe lower urinary tract obstruction (LUTO). J Pediatr Urol 2022; 18:129-130. [PMID: 35337732 DOI: 10.1016/j.jpurol.2022.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 11/15/2022]
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Lesieur E, Barrois M, Bourdon M, Blanc J, Loeuillet L, Delteil C, Torrents J, Bretelle F, Grangé G, Tsatsaris V, Anselem O. Megacystis in the first trimester of pregnancy: Prognostic factors and perinatal outcomes. PLoS One 2021; 16:e0255890. [PMID: 34492029 PMCID: PMC8423287 DOI: 10.1371/journal.pone.0255890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 07/26/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine whether bladder size is associated with an unfavorable neonatal outcome, in the case of first-trimester megacystis. MATERIALS AND METHODS This was a retrospective observational study between 2009 and 2019 in two prenatal diagnosis centers. The inclusion criterion was an enlarged bladder (> 7 mm) diagnosed at the first ultrasound exam between 11 and 13+6 weeks of gestation. The main study endpoint was neonatal outcome based on bladder size. An adverse outcome was defined by the completion of a medical termination of pregnancy, the occurrence of in utero fetal death, or a neonatal death. Neonatal survival was considered as a favorable outcome and was defined by a live birth, with or without normal renal function, and with a normal karyotype. RESULTS Among 75 cases of first-trimester megacystis referred to prenatal diagnosis centers and included, there were 63 (84%) adverse outcomes and 12 (16%) live births. Fetuses with a bladder diameter of less than 12.5 mm may have a favorable outcome, with or without urological problems, with a high sensitivity (83.3%) and specificity (87.3%), area under the ROC curve = 0.93, 95% CI (0.86-0.99), p< 0.001. Fetal autopsy was performed in 52 (82.5%) cases of adverse outcome. In the 12 cases of favorable outcome, pediatric follow-up was normal and non-pathological in 8 (66.7%). CONCLUSION Bladder diameter appears to be a predictive marker for neonatal outcome. Fetuses with smaller megacystis (7-10 mm) have a significantly higher chance of progressing to a favorable outcome. Urethral stenosis and atresia are the main diagnoses made when first-trimester megacystis is observed. Karyotyping is important regardless of bladder diameter.
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Affiliation(s)
| | - Mathilde Barrois
- Maternité Port-Royal, AP-HP, Hôpital Cochin, FHU PREMA, Paris, France
| | - Mathilde Bourdon
- Faculté de Médecine Paris Centre, Faculté de Santé, Université de Paris, Paris, France
- Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department “Infection, Immunity and Inflammation”, Université de Paris, Institut Cochin, Paris, France
| | - Julie Blanc
- Service de Gynécologie Obstétrique, Hôpital Nord, AP-HM, Chemin des Bourrely, Marseille, France
- EA3279, CEReSS, Health Service Research and Quality of Life Center, Université Aix-Marseille, Marseille, France
| | - Laurence Loeuillet
- Service d’Histologie-Embryologie-Cytogénétique, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Clémence Delteil
- Institut Médicolégal de Marseille, Hôpital Timone Adultes, Marseille, France
- CNRS, EFS, ADES UMR 7268, Aix-Marseille université, Marseille, France
| | - Julia Torrents
- Service d’Anatomo-Cytopathologie et Fœtopathologie, Hôpital de la Timone, Marseille, France
| | - Florence Bretelle
- Service de Gynécologie Obstétrique, Hôpital Nord, AP-HM, Chemin des Bourrely, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, MEФI, Marseille, France
| | - Gilles Grangé
- Maternité Port-Royal, AP-HP, Hôpital Cochin, FHU PREMA, Paris, France
| | - Vassilis Tsatsaris
- Maternité Port-Royal, AP-HP, Hôpital Cochin, FHU PREMA, Paris, France
- Université de Paris, Inserm UMR-S 1139, Physiopathologie et Pharmacotoxicologie Placentaire Humaine, Paris, France
| | - Olivia Anselem
- Maternité Port-Royal, AP-HP, Hôpital Cochin, FHU PREMA, Paris, France
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