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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.
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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
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Farmakis SG, Herman TE, Siegel MJ. Neonatal presentation of posterior urethral valves and tethered spinal cord. J Perinatol 2014; 34:647-8. [PMID: 25073498 DOI: 10.1038/jp.2014.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 12/23/2013] [Indexed: 11/09/2022]
Affiliation(s)
- S G Farmakis
- Mallinckrodt Institute of Radiology, St Louis Children's Hospital, Washington University School of Medicine, St Louis, MO, USA
| | - T E Herman
- Mallinckrodt Institute of Radiology, St Louis Children's Hospital, Washington University School of Medicine, St Louis, MO, USA
| | - M J Siegel
- Mallinckrodt Institute of Radiology, St Louis Children's Hospital, Washington University School of Medicine, St Louis, MO, USA
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Spaggiari E, Dreux S, Czerkiewicz I, Favre R, Schmitz T, Guimiot F, Laurichesse Delmas H, Verspyck E, Oury JF, Ville Y, Muller F. Fetal obstructive uropathy complicated by urinary ascites: outcome and prognostic value of fetal serum β-2-microglobulin. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:185-189. [PMID: 23090907 DOI: 10.1002/uog.12328] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/02/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To determine whether the prognostic value of fetal serum β-2-microglobulin is altered and whether the occurrence of fetal urinary ascites prevents kidney damage in cases of fetal obstructive uropathy with urinary ascites. METHODS This was a retrospective study of cases of fetal bilateral obstructive uropathy that occurred between 2006 and 2010, for which both fetal serum and ascites samples were sent to our laboratory for analysis. β-2-microglobulin was assayed in both fetal serum and the corresponding ascites. Renal outcome was analyzed. Histological features of the kidney in cases of termination of pregnancy and renal function of liveborn infants were recorded. RESULTS Fourteen cases with analysis of fetal serum and fetal ascites in a context of urinary obstruction were included. Renal outcome was unfavorable in eight cases (57%) and favorable in six (43%). When fetal serum β-2-microglobulin was < 5 mg/L, renal outcome was favorable in all cases (4/4). When fetal serum β-2-microglobulin was ≥ 5 mg/L, 8/10 cases (80%) had an unfavorable renal outcome (sensitivity, 100%; specificity, 66%). CONCLUSION Fetal serum β-2-microglobulin reliably predicts postnatal renal outcome in obstructive uropathy complicated by urinary ascites. Moreover, urine extravasation does not seem to protect fetal renal function.
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Affiliation(s)
- E Spaggiari
- Department of Developmental Biology, AP-HP, Robert Debré Hospital, and University Paris Diderot and Paris Sorbonne-Cité, Paris, France.
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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]
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Adorisio O, Silveri M, Colajacomo M, Bassani F, Rivosecchi M. The impact of perinatal urinoma formation on renal function: our experience and review of the literature. J Paediatr Child Health 2011; 47:217-22. [PMID: 21199055 DOI: 10.1111/j.1440-1754.2010.01927.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION A urinoma is a fluid mass consisting of extravasated urine in the perirenal space. Its impact on renal function was analysed. METHODS All cases of prenatal and neonatal urinoma reported in the literature were analysed as well as two cases recently observed in our department. RESULTS A review of all prenatally diagnosed urinomas revealed 25 cases, for a total of 30 renal units. The cause of obstruction was: lower urinary tract (LUT) obstruction in 16 cases (62.5%), upper urinary tract (UUT) obstruction in seven cases (29.5%) and unknown in two cases (8%). A preserved renal function was found in only 30% of all cases. Furthermore, prognosis for renal function was better in posterior urethral valve (PUV) patients than in uretero-pelvic junction obstruction (UPJO) patients. In addition, we analysed 35 published cases of urinoma with a neonatal onset, without prenatal diagnosis, and secondary to LUT obstruction in 27 cases (77%), UUT obstruction in seven cases (20%), while the underlying cause was unknown in one cases (3%). A preserved renal function was observed in 84% of cases with UUT obstruction and in 80% of cases presenting a LUT obstruction. CONCLUSIONS Prognosis concerning renal function seems to be mainly related to two factors: age at presentation and underlying diagnosis. Decompression of the urinary tract by urine extravasation produces the best results in terms of preservation of the renal function in LUT obstruction (75% in prenatal and 84% in postnatal cases); UUT obstruction however is associated with a good prognosis in the neonatal period (80% of preserved renal function) but with a severe impairment (only 20% of preserved renal function) in prenatally detected cases.
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Affiliation(s)
- Ottavio Adorisio
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy.
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Guyot A, Rosenblatt J, Bidat L, Bensman A, Bénifla JL, Jouannic JM. [Impact of fetal urinary ascites on serum beta2 microglobuline in obstructive uropathies: a case report]. J Gynecol Obstet Hum Reprod 2010; 39:418-421. [PMID: 20605369 DOI: 10.1016/j.jgyn.2010.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 04/09/2010] [Accepted: 04/28/2010] [Indexed: 05/29/2023]
Abstract
We report a posterior urethral valves case diagnosed at 33 week's gestation on a fetus presenting with anamnios and urinary ascites. In this fetus, the serum beta2 microglobuline rate was high, suggesting a very poor renal prognosis. At 1-year-old, the creatinine rate is nearly normal. In case of urinary ascites, the serum beta2 microglobuline rate could be improved in relation with the transperitoneal reabsorption of this protein.
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Affiliation(s)
- A Guyot
- Service de gynécologie-obstétrique, centre pluridisciplinaire de diagnostic prénatal de l'est parisien, hôpital Armand-Trousseau, AP-HP, Paris-6, 26, avenue Arnold-Netter, 75012 Paris, France
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Spasojevic S, Pavlovic V, Stojanovic V, Kovacevic B, Doronjski A. Prenatal urinary ascites due to the idiopathic bladder rupture. J Matern Fetal Neonatal Med 2009; 22:537-9. [DOI: 10.1080/14767050802702331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Matsui F, Shimada K, Matsumoto F, Obara T. Prenatal resolution of megacystis possibly caused by spontaneous rupture of posterior urethral valves. J Pediatr Surg 2008; 43:2285-7. [PMID: 19040955 DOI: 10.1016/j.jpedsurg.2008.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 07/24/2008] [Accepted: 08/01/2008] [Indexed: 12/01/2022]
Abstract
We report herein a case of resolution of severe megacystis, possibly caused by spontaneous rupture of posterior urethral valves during follow-up on a prenatal ultrasound. A 32-year-old woman presented at gestational week 15 for evaluation of fetal bladder enlargement. Prenatal ultrasonography revealed megacystis and posterior urethral dilatation. The longitudinal diameter of the bladder was 25 mm. Megacystis spontaneously resolved at gestational week 16. No association with urinary ascites was observed, and amniotic fluid volume remained normal throughout gestation. A boy was delivered vaginally at week 37. Apgar scores were 8 at 1 minute and 9 at 5 minutes. The neonate voided smoothly. Ultrasonography revealed a thickened bladder wall and normal kidneys and upper urinary tracts. Voiding cystourethrography showed dilatation of the posterior urethra but confirmed normal bladder capacity with smooth voiding and no vesicoureteral reflux. On day 57, remnant valves were incised. Postoperatively, filling cystometry showed a compliant bladder with no involuntary phasic contraction. At 7 months follow-up, the infant was asymptomatic, and ultrasonography showed some improvement of bladder wall thickness. Resolution of megacystis in utero appears to have resulted from spontaneous rupture of the posterior urethral valves. To the best of our knowledge, no similar cases have been previously reported.
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Affiliation(s)
- Futoshi Matsui
- Department of Urology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
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Gorincour G, Rypens F, Toiviainen-Salo S, Grignon A, Lambert R, Audibert F, Garel L, Fournet JC. Fetal urinoma: two new cases and a review of the literature. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 28:848-52. [PMID: 16941574 DOI: 10.1002/uog.2830] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To evaluate the functional prognosis of kidneys affected prenatally by urinomas. METHODS This was a retrospective review of cases of fetal urinoma reported in the literature, as well as two of our own cases. RESULTS Twenty-three patients with a prenatal diagnosis of urinoma (five bilateral) were included in the analysis. Postnatal ipsilateral renal function was observed in only six of the 28 renal units (i.e. around 20%). CONCLUSIONS Although the precise causes of urinomas are still unknown, this review shows that in the event of a fetal urinoma, the probability of a non-functional dysplastic ipsilateral kidney lies at around 80%. In-utero puncture only appears to be justified in cases where fluid accumulation has mass effects on adjacent major structures.
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Affiliation(s)
- G Gorincour
- Department of Pediatric Radiology, Sainte Justine Hospital, Montreal, Quebec, Canada.
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Stein RJ, Noh PH, Wu HY. Urinary ascites without hydronephrosis in a neonate with urethral atresia. Urology 2005; 66:432. [PMID: 16051320 DOI: 10.1016/j.urology.2005.03.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2004] [Revised: 02/24/2005] [Accepted: 03/29/2005] [Indexed: 11/28/2022]
Abstract
Urethral atresia is a rare and usually fatal cause of prenatal bladder outlet obstruction. We present a case of urethral atresia with urinary ascites to highlight the difficulties in making the diagnosis in the absence of hydronephrosis. We also discuss possible reasons why this patient maintained normal renal and pulmonary function.
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Affiliation(s)
- Robert J Stein
- Department of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
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Merrot T, Chaumoître K, Shojai R, D'Ercole C, Alessandrini P. Fetal bladder rupture due to anteriorurethral valves. Urology 2003; 61:1259. [PMID: 12809917 DOI: 10.1016/s0090-4295(03)00103-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A rupture of the fetal bladder that resulted in urinary ascites has rarely been reported in published studies. We present the first case of a spontaneous rupture of the fetal bladder, due to an anterior urethral valve, in which the diagnosis was suspected prenatally by means of Doppler ultrasonography and was confirmed postnatally.
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Affiliation(s)
- Thierry Merrot
- Département de Chirurgie Pédiatrique, Université de la Méditérranée, Hôpital Nord, AP-HM Nord, Hôpital Mère-Enfants, Marseille, France
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Löwenstein L, Solt I, Talmon R, Pery M, Suhov P, Drugan A. In utero diagnosis of bladder perforation with urinary ascites. A case report. Fetal Diagn Ther 2003; 18:179-82. [PMID: 12711873 DOI: 10.1159/000069374] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2002] [Indexed: 11/19/2022]
Abstract
Prenatal sonographic diagnosis of fetal obstructive uropathy is relatively common. However, the complication of spontaneous rupture of the obstructed bladder in utero causing fetal urinary ascites is extremely rare. This case report describes an unusual case of congenital bladder perforation and urinary ascites diagnosed in utero. The pertinent literature is reviewed.
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Affiliation(s)
- Lior Löwenstein
- Obstetrics and Gynecology Department, Rambam Medical Center, Haifa, Israel.
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Abstract
Ultrasound has become the modality of choice for the evaluation of the neonatal genitourinary tract. High frequency linear, vector, and curved array transducers (7 MHz, 5 MHz, 12 MHz) and portability of the equipment make a rapid bedside evaluation with exquisite anatomic detail possible. A major advantage of sonography over other modalities is real time observation and circumvention of sedation.
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Affiliation(s)
- D E Blews
- Department of Radiology, Scottish Rite Children's Medical Center, Atlanta, Georgia, USA
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