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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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Nishi K, Ozawa K, Kamei K, Sato M, Ogura M, Muromoto J, Sugibayashi R, Isayama T, Ito Y, Wada S, Yokoo T, Ishikura K. Long-Term Outcomes, Including Fetal and Neonatal Prognosis, of Renal Oligohydramnios: A Retrospective Study over 22 Years. J Pediatr 2024; 273:114151. [PMID: 38880380 DOI: 10.1016/j.jpeds.2024.114151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/02/2024] [Accepted: 06/11/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To assess the long-term outcome of renal oligohydramnios and risk factors for fetal, neonatal, and postneonatal death. STUDY DESIGN This retrospective cohort study included fetuses with prenatally detected renal oligohydramnios between 2002 and 2023. Patients who were lost to follow-up were excluded. Fetal, neonatal, and long-term outcomes were evaluated, and their risk factors were analyzed. RESULTS Of 131 fetuses with renal oligohydramnios, 46 (35%) underwent a termination of pregnancy, 11 (8%) had an intrauterine fetal death, 26 (20%) had a neonatal death, nine (7%) had a postneonatal death, and 39 (30%) survived. Logistic regression analyses showed that an earlier gestational age at onset (OR 1.16, 95% CI 1.01-1.37) was significantly associated with intrauterine fetal death; anhydramnios (OR 12.7, 95% CI 1.52-106.7) was significantly associated with neonatal death as a prenatal factor. Although neonatal survival rates for bilateral renal agenesis, bilateral multicystic dysplastic kidney (MCDK), and unilateral MCDK with contralateral renal agenesis were lower than for other kidney diseases, 1 case of bilateral renal agenesis and two of bilateral MCDK survived with fetal intervention. Kaplan-Meier overall survival rates were 57%, 55%, and 51% for 1, 3, and 5 years, respectively. In the Cox proportional hazards model, birth weight <2000 g (hazard ratio 7.33, 95% CI 1.48-36.1) and gastrointestinal comorbidity (hazard ratio 4.37, 95% CI 1.03-18.5) were significant risk factors for postneonatal death. CONCLUSION Long-term survival following renal oligohydramnios is a feasible goal and its appropriate risk assessment is important.
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Affiliation(s)
- Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Katsusuke Ozawa
- Division of Fetal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Jin Muromoto
- Division of Fetal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Rika Sugibayashi
- Division of Fetal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Tetsuya Isayama
- Division of Neonatology, Center for Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Yushi Ito
- Division of Neonatology, Center for Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Seiji Wada
- Division of Fetal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenji Ishikura
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan.
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Gottschalk I, Berg C, Menzel T, Abel JS, Kribs A, Dübbers M, Kohaut J, Weber LT, Taylan C, Habbig S, Liebau MC, Boemers TM, Weber EC. Single-center outcome analysis of 46 fetuses with megacystis after intrauterine vesico-amniotic shunting with the Somatex®intrauterine shunt. Arch Gynecol Obstet 2024; 309:145-158. [PMID: 36604332 PMCID: PMC10770195 DOI: 10.1007/s00404-022-06905-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To assess the spectrum of underlying pathologies, the intrauterine course and postnatal outcome of 46 fetuses with megacystis that underwent intrauterine vesico-amniotic shunting (VAS) with the Somatex® shunt in a single center. METHODS Retrospective analysis of 46 fetuses with megacystis that underwent VAS either up to 14 + 0 weeks (early VAS), between 14 + 1 and 17 + 0 weeks (intermediate VAS) or after 17 + 0 weeks of gestation (late VAS) in a single tertiary referral center. Intrauterine course, underlying pathology and postnatal outcome were assessed and correlated with the underlying pathology and gestational age at first VAS. RESULTS 46 fetuses underwent VAS, 41 (89%) were male and 5 (11%) were female. 28 (61%) fetuses had isolated and 18 (39%) had complex megacystis with either aneuploidy (n = 1), anorectal malformations (n = 6), cloacal malformations (n = 3), congenital anomalies overlapping with VACTER association (n = 6) or Megacystis-Microcolon Intestinal-Hypoperistalsis Syndrome (MMIHS) (n = 2). The sonographic 'keyhole sign' significantly predicted isolated megacystis (p < 0.001). 7 pregnancies were terminated, 4 babies died in the neonatal period, 1 baby died at the age of 2.5 months and 34 (74%) infants survived until last follow-up. After exclusion of the terminated pregnancies, intention-to-treat survival rate was 87%. Mean follow-up period was 24 months (range 1-72). The underlying pathology was highly variable and included posterior urethral valve (46%), hypoplastic or atretic urethra (35%), MMIHS or prune belly syndrome (10%) and primary vesico-ureteral reflux (2%). In 7% no pathology could be detected postnatally. No sonographic marker was identified to predict the underlying pathology prenatally. 14 fetuses underwent early, 24 intermediate and 8 late VAS. In the early VAS subgroup, amnion infusion prior to VAS was significantly less often necessary (7%), shunt complications were significantly less common (29%) and immediate kidney replacement therapy postnatally became less often necessary (0%). In contrast, preterm delivery ≤ 32 + 0 weeks was more common (30%) and survival rate was lower (70%) after early VAS compared to intermediate or late VAS. Overall, 90% of liveborn babies had sufficient kidney function without need for kidney replacement therapy until last follow-up, and 95% had sufficient pulmonary function without need for mechanical respiratory support. 18% of babies with complex megacystis suffered from additional health restrictions due to their major concomitant malformations. CONCLUSIONS Our data suggest that VAS is feasible from the first trimester onward. Early intervention has the potential to preserve neonatal kidney function in the majority of cases and enables neonatal survival in up to 87% of cases. Despite successful fetal intervention, parents should be aware of the potential of mid- or long-term kidney failure and of additional health impairments due to concomitant extra-renal anomalies that cannot be excluded at time of intervention.
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Affiliation(s)
- I Gottschalk
- Division of Prenatal Medicine, Fetal Surgery and Gynecological Ultrasound, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany.
| | - C Berg
- Division of Prenatal Medicine, Fetal Surgery and Gynecological Ultrasound, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - T Menzel
- Division of Prenatal Medicine, Fetal Surgery and Gynecological Ultrasound, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - J S Abel
- Division of Prenatal Medicine, Fetal Surgery and Gynecological Ultrasound, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - A Kribs
- Department of Neonatology, University Hospital of Cologne, Cologne, Germany
| | - M Dübbers
- Division of Pediatric Surgery, University Hospital of Cologne, Cologne, Germany
| | - J Kohaut
- Division of Pediatric Surgery, University Hospital of Cologne, Cologne, Germany
| | - L T Weber
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - C Taylan
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - S Habbig
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - M C Liebau
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - T M Boemers
- Department of Pediatric Surgery and Urology, Children´S Academic Hospital Amsterdamer Cologne, Cologne, Germany
| | - E C Weber
- Division of Prenatal Medicine, Fetal Surgery and Gynecological Ultrasound, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
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Kohaut J, Fischer-Mertens J, Cernaianu G, Schulten D, Holtkamp G, Kohl S, Habbig S, Klein R, Kribs A, Gottschalk I, Berg C, Dübbers M. Postnatal surgical treatment and complications following intrauterine vesicoamniotic shunting with the SOMATEX® intrauterine shunt. A single center experience. J Pediatr Urol 2023; 19:567.e1-567.e6. [PMID: 37451915 DOI: 10.1016/j.jpurol.2023.06.027] [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: 02/22/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Intrauterine vesicoamniotic shunting (VAS) using a Somatex® shunt was shown to significantly affect survival of male fetuses with megacystis in suspected lower urinary tract obstruction (LUTO) [Figure 1]. Data on postnatal surgical management and complications are largely lacking. OBJECTIVE To describe the postnatal management of patients with prenatal VAS for megacystitis in suspected severe LUTO. STUDY DESIGN All male newborns with previous intrauterine VAS using a Somatex® shunt treated in our institution were retrospectively analyzed. We evaluated the spectrum of urethral pathologies and postnatal surgical management, especially focusing on shunt removal. RESULTS Between 2016 and 2022, 17 patients (all male) were treated postnatally in our institution after VAS for suspected severe LUTO. Five fetuses with dislocated shunts underwent re-implantation in utero. Overall, premature birth before the 38th week of gestation was observed in eight patients (8/17). Seven shunts could be removed without further anesthesia as a bedside procedure. Ten patients required surgical shunt removal under general anesthesia due to migration (59%). Laparoscopic shunt extraction was performed in 8/10 cases. Most frequently, dislocated shunts were located incorporated in the detrusor in eight cases and the removal required a bladder suture in 2/8 patients. In one case, the shunt was removed from the abdominal wall and in one case from the intestine wall [Figure 2]. Posterior urethral valves were found in 8/17 patients, 6/17 patients showed a urethral atresia and one patient had urethral duplication. In two patients, we identified a high grade bilateral vesicoureteral reflux without LUTO. CONCLUSION In our observation, more than half of the newborns with megacystis in suspected LUTO require a shunt removal surgery after early VAS using a Somatex® shunt. Urethral atresia may be found more frequently in these patients. These data should be taken into consideration for prenatal counselling of parents and planning of postnatal management.
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Affiliation(s)
- J Kohaut
- Division of Pediatric Surgery, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - J Fischer-Mertens
- Division of Pediatric Surgery, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - G Cernaianu
- Division of Pediatric Surgery, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - D Schulten
- Division of Pediatric Surgery, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - G Holtkamp
- Division of Pediatric Surgery, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - S Kohl
- Department of Pediatrics and Adolescent Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - S Habbig
- Department of Pediatrics and Adolescent Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - R Klein
- Department of Pediatrics and Adolescent Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - A Kribs
- Department of Pediatrics and Adolescent Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - I Gottschalk
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - C Berg
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - M Dübbers
- Division of Pediatric Surgery, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
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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.
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Affiliation(s)
- Marie Cassart
- Radiology Department, Iris South Hospitals, Site Elterbeek-Ixelles, 63 Rue Jean Paquot, 1050, Brussels, Belgium.
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Ormonde M, Carrilho B, Carneiro R, Alves F, Cohen Á, Martins AT. Fetal Megacystis in the first trimester: Comparing management and outcomes between longitudinal bladder length groups. J Gynecol Obstet Hum Reprod 2023; 52:102503. [PMID: 36372362 DOI: 10.1016/j.jogoh.2022.102503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 11/13/2022]
Abstract
Fetal megacystis is a sonographic sign, defined in first trimester as a longitudinal bladder length (LBD)>7 mm. Different causes may be associated with megacystis and outcomes vary with many factors. There are no international guidelines on how to manage megacystis cases, and invasive testing is controversial when no other abnormalities are found. The main objective of this study is to compare etiologies, management and outcomes of fetuses with first trimester megacystis, specifically between groups of LBD≤15 mm and >15 mm. This is a retrospective cohort study of megacystis cases managed in a Prenatal Diagnosis Center, between January 2009 and September 2020. Descriptive and bivariate analysis were performed. We studied 43 fetuses: 67.4% with LBD≤15 mm and 32.6% with LBD>15 mm. We found an association between LBD and isolated Low Urinary Tract Obstruction (LUTO) (3.4% vs 64.3%; p<0.001) and with isolated megacystis (44.8% vs 0.0%; p = 0.001). No differences were seen regarding the presence of aneuploidies (31.0% vs 14.3%; p = 0.213). Invasive testing was performed in 93.0% of cases. Overall, we report 41.9% of live births, 39.5% of pregnancy termination and 18.6% of intrauterine fetal demise. We found a higher rate of live births in fetuses with LBD≤15 mm (55.2% vs 14.3%; p = 0.011). For a mean follow-up time of 20.6 months, we report one neonatal death and one case of renal insufficiency. In conclusion, isolated LUTO is more frequent if LBD>15 mm whereas isolated megacystis is more frequently found if LBD≤15 mm. If LBD≤15 mm, live birth rates and long-term outcomes seem to be enhanced.
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Affiliation(s)
- Mariana Ormonde
- Resident in Obstetrics & Gynecology, Obstetrics and Gynecology Department, Hospital do Divino Espírito Santo de Ponta Delgada, Azores, Portugal.
| | - Bruno Carrilho
- Attending in Obstetrics & Gynecology, Prenatal Diagnosis Unit, Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Rita Carneiro
- Attending in Radiology, Radiology Department, Hospital D. Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Fátima Alves
- Attending in Pediatric Surgery, Urology Unit, Hospital D. Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Álvaro Cohen
- Attending in Obstetrics & Gynecology, Prenatal Diagnosis Unit, Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Ana Teresa Martins
- Attending in Obstetrics & Gynecology, Prenatal Diagnosis Unit, Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
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Strizek B, Spicher T, Gottschalk I, Böckenhoff P, Simonini C, Berg C, Gembruch U, Geipel A. Vesicoamniotic Shunting before 17 + 0 Weeks in Fetuses with Lower Urinary Tract Obstruction (LUTO): Comparison of Somatex vs. Harrison Shunt Systems. J Clin Med 2022; 11:jcm11092359. [PMID: 35566484 PMCID: PMC9101314 DOI: 10.3390/jcm11092359] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 01/27/2023] Open
Abstract
(1) Background: The aim of this study was to compare perinatal outcomes and complication rates of vesicoamniotic shunting (VAS) before 17 + 0 weeks in isolated LUTO (lower urinary tract obstruction) with the Somatex® intrauterine shunt vs. the Harrison fetal bladder shunt. (2) Methods: This is a retrospective cohort study in two tertiary fetal medicine centers. From 2004−2014, the Harrison fetal bladder shunt was used, and from late 2014−2017, the Somatex shunt. Obstetrics and pediatric charts were reviewed for complications, course of pregnancy, perinatal outcome, and postnatal renal function. (3) Results: Twenty-four fetuses underwent VAS with a Harrison (H) shunt and 33 fetuses with a Somatex (S) shunt. Live birth rates and survival to last follow-up were significantly higher in the Somatex group, at 84.8% and 81.8%, respectively, vs. 50% and 33.3% in the Harrison group (p = 0.007 and p < 0.001). The dislocation rate in the Somatex group (36.4%) was significantly lower than in the Harrison group (87.5%) (p < 0.001). The median time to dislocation was significantly different, at 20.6 days (H) vs. 73.9 days (S) (p = 0.002), as was gestational age at dislocation (17 (H) vs. 25 (S) weeks, p < 0.001). Renal function was normal in early childhood in 51% (S) vs. 29% (H) (p = 0.11). (4) Conclusions: VAS before 17 + 0 weeks gestational age with a Somatex shunt improves perinatal survival significantly and might even have a positive effect on renal function, probably due to the lower dislocation rates. A normal amount of amniotic fluid in the third trimester was the best predictor of normal renal function in early childhood.
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Affiliation(s)
- Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (B.S.); (T.S.); (P.B.); (C.S.); (U.G.)
| | - Theresa Spicher
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (B.S.); (T.S.); (P.B.); (C.S.); (U.G.)
| | - Ingo Gottschalk
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital Cologne, 50937 Cologne, Germany; (I.G.); (C.B.)
| | - Paul Böckenhoff
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (B.S.); (T.S.); (P.B.); (C.S.); (U.G.)
| | - Corinna Simonini
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (B.S.); (T.S.); (P.B.); (C.S.); (U.G.)
| | - Christoph Berg
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital Cologne, 50937 Cologne, Germany; (I.G.); (C.B.)
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (B.S.); (T.S.); (P.B.); (C.S.); (U.G.)
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (B.S.); (T.S.); (P.B.); (C.S.); (U.G.)
- Correspondence: ; Tel.: +49-228-287-37116
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Keil C, Bedei I, Sommer L, Koemhoff M, Axt-Fliedner R, Köhler S, Weber S. Fetal therapy of LUTO (lower urinary tract obstruction) - a follow-up observational study. J Matern Fetal Neonatal Med 2021; 35:8536-8543. [PMID: 34652254 DOI: 10.1080/14767058.2021.1988562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Fetal megacystis (MC) can be severe and is mainly caused by fetal lower urinary tract obstruction (LUTO). Mortality of fetal LUTO can be high as a result of pulmonary hypoplasia and/or (chronic) renal insufficiency. Several technical procedures for vesicoamniotic shunting (VAS) were developed to improve fetal MC outcomes. MATERIAL AND METHODS We present the outcome of nine fetuses with MC who received VAS in the prenatal period (14 + 6 to 27 + 6 weeks GA) using the Somatex® intrauterine shunt system. MC was defined as an increased longitudinal measurement of the bladder >15 mm. The median follow-up time after birth was 18 months. RESULTS Eight Fetuses had uncomplicated VAS intervention. One case developed PPROM 24 h after VAS leading to abortion. Pregnancy was later terminated in further two cases. All six live-born infants received intensive care treatment. Invasive-mechanical ventilation was necessary in one case who died 24 h post-partum of severe cardiac depression. Five infants who survived the follow-up time developed chronic renal insufficiency (CRI), with one infant developing end-stage renal failure requiring peritoneal dialysis. CONCLUSION Overall, 5 of 9 LUTO fetuses (55%) undergoing VAS with the Somatex® intrauterine shunt system showed long-term survival beyond the neonatal period of 28 d (5/9; 55%) with varying morbidity.
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Affiliation(s)
- Corinna Keil
- Division of Prenatal Medicine and Therapy, Department of Obstetrics and Perinatal Medicine, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Ivonne Bedei
- Division of Prenatal Medicine and Therapy, Department of Obstetrics and Perinatal Medicine, University Hospital Giessen, Liebig University Giessen, Giessen, Germany
| | - Lara Sommer
- University Children Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Martin Koemhoff
- University Children Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Roland Axt-Fliedner
- Division of Prenatal Medicine and Therapy, Department of Obstetrics and Perinatal Medicine, University Hospital Giessen, Liebig University Giessen, Giessen, Germany
| | - Siegmund Köhler
- Division of Prenatal Medicine and Therapy, Department of Obstetrics and Perinatal Medicine, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Stefanie Weber
- University Children Hospital Marburg, Philipps University Marburg, Marburg, Germany
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9
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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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10
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Keefe DT, Kim JK, Mackay E, Chua M, Van Mieghem T, Yadav P, Lolas M, Santos JD, Skreta M, Erdman L, Weaver J, Fermin AS, Tasian G, Lorenzo AJ, Rickard M. Predictive accuracy of prenatal ultrasound findings for lower urinary tract obstruction: A systematic review and Bayesian meta-analysis. Prenat Diagn 2021; 41:1039-1048. [PMID: 34318486 DOI: 10.1002/pd.6025] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lower urinary tract obstruction (LUTO) is a rare but critical fetal diagnosis. Different ultrasound markers have been reported with varying sensitivity and specificity. AIMS The objective of this systematic review and meta-analysis was to identify the diagnostic accuracy of ultrasound markers for LUTO. MATERIALS AND METHODS We performed a systematic literature review of studies reporting on fetuses with hydronephrosis or a prenatally suspected and/or postnatally confirmed diagnosis of LUTO. Bayesian bivariate random effects meta-analytic models were fitted, and we calculated posterior means and 95% credible intervals for the pooled diagnostic odds ratio (DOR). RESULTS A total of 36,189 studies were identified; 636 studies were available for full text review and a total of 42 studies were included in the Bayesian meta-analysis. Among the ultrasound signs assessed, megacystis (DOR 49.15, [15.28, 177.44]), bilateral hydroureteronephrosis (DOR 41.33, [13.36,164.83]), bladder thickening (DOR 13.73, [1.23, 115.20]), bilateral hydronephrosis (DOR 8.36 [3.17, 21.91]), male sex (DOR 8.08 [3.05, 22.82]), oligo- or anhydramnios (DOR 7.75 [4.23, 14.46]), and urinoma (DOR 7.47 [1.14, 33.18]) were found to be predictive of LUTO (Table 1). The predictive sensitivities and specificities however are low and wide study heterogeneity existed. DISCUSSION Classically, LUTO is suspected in the presence of prenatally detected megacystis with a dilated posterior urethra (i.e., the keyhole sign), and bilateral hydroureteronephrosis. However, keyhole sign has been found to have modest diagnostic performance in predicting the presence of LUTO in the literature which we confirmed in our analysis. The surprisingly low specificity may be influenced by several factors, including the degree of obstruction, and the diligence of the sonographer at searching for and documenting it during the scan. As a result, providers should consider this when establishing the differential for a fetus with hydronephrosis as the presence or absence of keyhole sign does not reliably rule in or rule out LUTO. CONCLUSIONS Megacystis, bilateral hydroureteronephrosis and bladder wall thickening are the most accurate predictors of LUTO. Given the significant consequences of a missed LUTO diagnosis, clinicians providing counselling for prenatal hydronephrosis should maintain a low threshold for considering LUTO as part of the differential diagnosis.
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Affiliation(s)
- Daniel T Keefe
- Division of Urology, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Jin Kyu Kim
- Division of Urology, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Michael Chua
- Division of Urology, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Tim Van Mieghem
- Department of Obstetrics and Gynecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Priyank Yadav
- Division of Urology, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Marisol Lolas
- Division of Urology, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Joana Dos Santos
- Division of Urology, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Marta Skreta
- Centre for Computational Medicine, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Lauren Erdman
- Centre for Computational Medicine, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - John Weaver
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Antoine Selman Fermin
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Gregory Tasian
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Mandy Rickard
- Division of Urology, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
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11
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Kao C, Lauzon J, Brundler MA, Tang S, Somerset D. Perinatal outcome and prognostic factors of fetal megacystis diagnosed at 11-14 week's gestation. Prenat Diagn 2020; 41:308-315. [PMID: 33219696 DOI: 10.1002/pd.5868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/09/2020] [Accepted: 11/17/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To evaluate aneuploidy rate, prognostic factors, and perinatal outcomes following a diagnosis of fetal megacystis at 11-14 week's gestation. METHODS A retrospective study of first trimester fetal megacystis from 2010 to 2020 was performed, including ultrasound finding, perinatal outcomes, pathology reports, genetic tests, and neonatal investigations. RESULTS A total of 98 cases of first trimester fetal megacystis was identified with an overall aneuploidy rate of 12%. There were 54% live births and 46% fetal losses including spontaneous fetal demise and elective termination. Among the 45 fetal losses, 64% had additional structural abnormalities at index ultrasound and final diagnoses were achievable in 64% cases. Among the 53 livebirths, additional ultrasound abnormalities were detected in only 1 fetus and spontaneous resolution of megacystis was detected in 96% of cases. The two cases where fetal megacystis persisted had major postnatal diagnoses: cloacal malformation and megacystis-microcolon-intestinal hypoperistalsis syndrome, respectively. Our data showed LBD ≥ 12 mm was the best individual predictor of adverse perinatal outcome and all 11 cases of lower urinary tract obstruction (LUTO) were diagnosed in fetuses with LBD ≥ 12 mm. CONCLUSIONS First trimester ultrasound provides important prognostic factors and isolated megacystis <12 mm is associated with a positive outcome.
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Affiliation(s)
- Cindy Kao
- Department of Obstetrics and Gynecology, University of Calgary, Alberta, Canada
| | - Julie Lauzon
- Department of Medical Genetics, University of Calgary, Alberta, Canada
| | - Marie-Anne Brundler
- Department of Pathology & Laboratory Medicine and Pediatrics, University of Calgary, Alberta, Canada
| | - Selphee Tang
- Department of Obstetrics and Gynecology, University of Calgary, Alberta, Canada
| | - David Somerset
- Department of Obstetrics and Gynecology, University of Calgary, Alberta, Canada
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12
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Strizek B, Gottschalk I, Recker F, Weber E, Flöck A, Gembruch U, Geipel A, Berg C. Vesicoamniotic shunting for fetal megacystis in the first trimester with a Somatex ® intrauterine shunt. Arch Gynecol Obstet 2020; 302:133-140. [PMID: 32449061 PMCID: PMC7266802 DOI: 10.1007/s00404-020-05598-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 05/08/2020] [Indexed: 11/30/2022]
Abstract
Purpose The objective was to evaluate the feasibility of vesicoamniotic shunting (VAS) in the first trimester with the Somatex® intrauterine shunt and report on complications and neonatal outcome. Methods Retrospective cohort study of all VAS before 14 weeks at two tertiary fetal medicine centres from 2015 to 2018 using a Somatex® intrauterine shunt. All patients with a first trimester diagnosis of megacystis in male fetuses with a longitudinal bladder diameter of at least 15 mm were offered VAS. All patients that opted for VAS after counselling by prenatal medicine specialists, neonatologists and pediatric nephrologists were included in the study. Charts were reviewed for complications, obstetric and neonatal outcomes. Results Ten VAS were performed during the study period in male fetuses at a median GA of 13.3 (12.6–13.9) weeks. There were two terminations of pregnancy (TOP) due to additional malformations and one IUFD. Overall there were four shunt dislocations (40%); three of those between 25–30 weeks GA. Seven neonates were born alive at a median GA of 35.1 weeks (31.0–38.9). There was one neonatal death due to pulmonary hypoplasia. Neonatal kidney function was normal in the six neonates surviving the neonatal period. After exclusion of TOP, perinatal survival was 75%, and 85.7% if only live-born children were considered. Conclusion VAS in the first trimester is feasible with the Somatex® Intrauterine shunt with low fetal and maternal complication rates. Neonatal survival rates are high due to a reduction in pulmonary hypoplasia and the rate of renal failure at birth is very low. VAS can be safely offered from the late first trimester using the Somatex® intrauterine shunt.
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Affiliation(s)
- B Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - I Gottschalk
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital Cologne, Cologne, Germany
| | - F Recker
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - E Weber
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - A Flöck
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - U Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - A Geipel
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - C Berg
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital Cologne, Cologne, Germany
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13
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The perineal midsagittal view in male fetuses - pivotal for assessing genitourinary disorders. Pediatr Radiol 2020; 50:575-582. [PMID: 31707446 DOI: 10.1007/s00247-019-04551-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/16/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
Abstract
A wide range of genitourinary pathologies can be diagnosed in utero, from a simple vesicoureteral reflux to a more complex disorder of sexual differentiation. The prognosis and neonatal management of these conditions differ significantly. Evaluation of the fetal perineal anatomy is paramount to making the right diagnosis. The aim of this pictorial essay is to show sonographers how to acquire a perineal midsagittal view in a male fetus, and to demonstrate how this specific view allows assessment of the urethra and penis, to differentiate various genitourinary pathologies.
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14
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Cheung KW, Morris RK, Kilby MD. Congenital urinary tract obstruction. Best Pract Res Clin Obstet Gynaecol 2019; 58:78-92. [PMID: 30819578 DOI: 10.1016/j.bpobgyn.2019.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/01/2019] [Accepted: 01/07/2019] [Indexed: 12/14/2022]
Abstract
Congenital bladder neck obstruction (or lower urinary tract obstruction [LUTO]) describes a heterogeneous group of congenital anomalies presenting with similar prenatal ultrasonographic findings of dilated posterior urethra, megacystis, hydronephrosis, oligohydramnios and often with associated renal dysplasia. Untreated LUTO has high rate of perinatal morbidity and mortality from associated pulmonary hypoplasia and early-onset renal failure in infancy. Ultrasonographic features and prospective fetal urinalysis may help in predicting the overall prognosis of congenital LUTO. Currently, fetal vesicoamniotic shunt (of various designs), and fetal cystoscopy and fulguration of the obstruction are potential prenatal interventions. Retrospective and prospective cohort studies and a relatively small randomized controlled trial have demonstrated these treatments may possibly improve perinatal survival. Despite this, concerns remain as to the high rates of renal impairment observed in paediatric survivors. A clinical prospective scoring/staging system may improve prenatal diagnostic criteria and case selection for fetal therapy.
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Affiliation(s)
- Ka Wang Cheung
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China; The Fetal Medicine Centre, Birmingham Women's and Children's Foundation Trust, Edgbaston, Birmingham, B15 2TG, UK.
| | - Rachel Katie Morris
- The Fetal Medicine Centre, Birmingham Women's and Children's Foundation Trust, Edgbaston, Birmingham, B15 2TG, UK; The Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Mark David Kilby
- The Fetal Medicine Centre, Birmingham Women's and Children's Foundation Trust, Edgbaston, Birmingham, B15 2TG, UK; The Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK
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15
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Chen L, Guan J, Gu H, Zhang M. Outcomes in fetuses diagnosed with megacystis: Systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2018; 233:120-126. [PMID: 30594021 DOI: 10.1016/j.ejogrb.2018.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/25/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To explore the outcomes and prognostic factors associated with fetal megacystis (enlarged bladder). STUDY DESIGN The MEDLINE and EMBASE databases were searched for studies reporting on outcomes of fetal megacystis. The outcomes observed were chromosomal abnormalities, associated structural anomalies, spontaneous resolution, and survival rates. We also evaluated the potential role of fetal gender, oligohydramnios, gestational age at diagnosis, and intrauterine intervention as prenatal prognostic factors. RESULTS The search identified 558 articles in total, and 13 studies (1675 fetuses) were included in this systematic review. The overall incidences of chromosomal abnormalities and associated structural anomalies in fetal megacystis were 10% and 24%, respectively. Spontaneous resolution of megacystis occurred in 32% of fetuses, and 44% of fetuses were born alive and survived until the follow-up. The odds ratio of survival with oligohydramnios was 0.14, and the mean difference in gestational age at diagnosis between survival and non-survival was 3.43 weeks. No significant difference in survival rate was observed between the genders, and an intrauterine intervention did not significantly improve the prognosis. CONCLUSIONS A considerable proportion of fetuses with megacystis are born with a good prognosis. Oligohydramnios and lower gestational age at diagnosis are associated with worse outcomes.
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Affiliation(s)
- Lizhu Chen
- Department of Ultrasound, Shengjing Hospital, China Medical University, Shenyang, China
| | - Johnny Guan
- Department of Urology, University of California Los Angeles, Los Angeles, CA, USA
| | - Hui Gu
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Mo Zhang
- Department of Urology, Shengjing Hospital, China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, Liaoning 110004, China.
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16
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Fontanella F, Duin L, Adama van Scheltema PN, Cohen-Overbeek TE, Pajkrt E, Bekker M, Willekes C, Bax CJ, Bilardo CM. Fetal megacystis: prediction of spontaneous resolution and outcome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:458-463. [PMID: 28133847 DOI: 10.1002/uog.17422] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/19/2016] [Accepted: 01/20/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To investigate the natural history of fetal megacystis from diagnosis in utero to postnatal outcome, and to identify prognostic indicators of spontaneous resolution and postnatal outcome after resolution. METHODS This was a national retrospective cohort study. Fetal megacystis was defined in the first trimester as a longitudinal bladder diameter (LBD) ≥ 7 mm, and in the second and third trimesters as an enlarged bladder failing to empty during the entire extended ultrasound examination. LBD and gestational age (GA) at resolution were investigated with respect to likelihood of resolution and postnatal outcome, respectively. Sensitivity, specificity and area under the receiver-operating characteristics curve (AUC) were calculated. RESULTS In total, 284 cases of fetal megacystis (93 early megacystis, identified before the 18th week, and 191 late megacystis, identified at or after the 18th week) were available for analysis. Spontaneous resolution occurred before birth in 58 (20%) cases. In cases with early megacystis, LBD was predictive of the likelihood of spontaneous resolution (sensitivity, 80%; specificity, 79%; AUC, 0.84), and, in the whole population, GA at regression was predictive of postnatal outcome, with an optimal cut-off at 23 weeks (sensitivity, 100%; specificity, 82%; AUC, 0.91). In the group with early megacystis, the outcome was invariably good when resolution occurred before the 23rd week of gestation, whereas urological sequelae requiring postnatal surgery were diagnosed in 3/8 (38%) cases with resolution after 23 weeks. In the group with late megacystis, spontaneous resolution was associated with urological complications after birth, ranging from mild postnatal hydronephrosis in infants with resolution before 23 weeks, to more severe urological anomalies requiring postnatal surgery in those with resolution later in pregnancy. This supports the hypothesis that an early resolution of megacystis is often related to a paraphysiological bladder enlargement that resolves early in pregnancy without consequences, while antenatal resolution occurring later in pregnancy (after the 23rd week of gestation) should suggest a pathological condition with urological sequelae. CONCLUSIONS In fetal megacystis, LBD and GA at regression can be used as predictors of resolution and outcome, respectively. These parameters could help in fine-tuning the prognosis and optimizing the frequency of follow-up scans. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F Fontanella
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - L Duin
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - P N Adama van Scheltema
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Leiden University Medical Centre, Leiden, The Netherlands
| | - T E Cohen-Overbeek
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - E Pajkrt
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - M Bekker
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - C Willekes
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Centre, Grow School for Oncology and Medical Biology, Maastricht, The Netherlands
| | - C J Bax
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, VU University Medical Centre, Amsterdam, The Netherlands
| | - C M Bilardo
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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17
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Pellegrino M, Visconti D, Catania VD, D'Oria L, Manzoni C, Grella MG, Caruso A, Masini L, Noia G. Prenatal detection of megacystis: not always an adverse prognostic factor. Experience in 25 consecutive cases in a tertiary referral center, with complete neonatal outcome and follow-up. J Pediatr Urol 2017; 13:486.e1-486.e10. [PMID: 28495235 DOI: 10.1016/j.jpurol.2017.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/13/2017] [Accepted: 04/10/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Megacystis is a condition of abnormal enlarged fetal bladder for gestational age, which is usually associated with urological malformations that may constitute a life-threatening condition for the baby. OBJECTIVE The purpose of this study was to assess the prognostic and etiological criteria of fetal megacystis and to describe the neonatal outcome in a large series collected in a single tertiary center. STUDY DESIGN A retrospective observational study was conducted between 2008 and 2012. We reviewed all consecutive cases of fetal megacystis diagnosed during routine ultrasound (US) screening. The following data were collected and analyzed: maternal age, gestational age at diagnosis, prenatal ultrasonographic details of the urinary system, extra-urinary ultrasonographic anomalies, fetal karyotype, pregnancy outcome, postnatal diagnosis, and medical/surgical follow-up. RESULTS Of the 25 fetuses included in this study, 76% were males. The mean gestational age (GA) at diagnosis was 23.1 ± 7.5 weeks (range 12-34), among them only four (16%) were diagnosed during the first trimester. Associated urological malformations were detected in 92% (n = 23) of the cases, while other malformations were detected in 36% (n = 9). Oligohydramnios or anyhydramnios were observed in 52% (n = 13) of the cases. Twelve (48%) fetuses were considered as having poor prognosis for renal function. Vesicocentesis with or without vesico-amniotic infusion were performed in 28% (n = 7) of the cases. Pregnancy outcome was surprisingly good, with only one case of prenatal death and survival rate of 96% (n = 24) of liveborn babies. Posterior urethral valve (PUV) (n = 9, 36%) was the most common etiology of the fetal megacystis, followed by persistent urogenital sinus (n = 2, 8%), Prune belly syndrome (n = 2, 8%) and bilateral vescico-ureteral reflux (VUR) (n = 2, 8%). Surgical or endoscopic procedures were performed in 75% (n = 18) of the cases. Six (24%) newborns presented with moderate/severe respiratory distress that requested invasive assisted ventilation. Three cases (n = 3, 12%) of perinatal death were observed due to severe impaired renal function. After a median follow-up of 29 months renal function was good in 79% (n = 19) of the cases. CONCLUSIONS Fetal megacystis may underline a wide range of associated pathologies with the highest prevalence of urinary malformation. Optimal counseling of the involved parents requires a multidisciplinary approach to allow the best management during the pregnancy and the perinatal period. Despite the high risk of renal failure, lung hypoplasia, and severe associated anomalies, the outcome of fetuses with megacystis could be improved thanks to an appropriate perinatal diagnosis and neonatal management.
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Affiliation(s)
- Marcella Pellegrino
- Department of Obstetrics and Gynecology, Fetal Diagnosis and Therapy Unit, Catholic University of Sacred Heart, Policlinico A. Gemelli Hospital, Rome, Italy.
| | - Daniela Visconti
- Department of Obstetrics and Gynecology, Fetal Diagnosis and Therapy Unit, Catholic University of Sacred Heart, Policlinico A. Gemelli Hospital, Rome, Italy
| | - Vincenzo Davide Catania
- Department of Pediatric Surgery, Pediatric Urology, Catholic University of Sacred Heart, Policlinico A. Gemelli Hospital, Rome, Italy
| | - Luisa D'Oria
- Department of Obstetrics and Gynecology, Fetal Diagnosis and Therapy Unit, Catholic University of Sacred Heart, Policlinico A. Gemelli Hospital, Rome, Italy
| | - Carlo Manzoni
- Department of Pediatric Surgery, Pediatric Urology, Catholic University of Sacred Heart, Policlinico A. Gemelli Hospital, Rome, Italy
| | - Maria Giovanna Grella
- Department of Pediatric Surgery, Pediatric Urology, Catholic University of Sacred Heart, Policlinico A. Gemelli Hospital, Rome, Italy
| | - Alessandro Caruso
- Department of Obstetrics and Gynecology, Fetal Diagnosis and Therapy Unit, Catholic University of Sacred Heart, Policlinico A. Gemelli Hospital, Rome, Italy
| | - Lucia Masini
- Department of Obstetrics and Gynecology, Fetal Diagnosis and Therapy Unit, Catholic University of Sacred Heart, Policlinico A. Gemelli Hospital, Rome, Italy
| | - Giuseppe Noia
- Department of Obstetrics and Gynecology, Fetal Diagnosis and Therapy Unit, Catholic University of Sacred Heart, Policlinico A. Gemelli Hospital, Rome, Italy
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Taghavi K, Sharpe C, Stringer MD, Zuccollo J, Marlow J. Fetal megacystis: Institutional experience and outcomes. Aust N Z J Obstet Gynaecol 2017; 57:636-642. [DOI: 10.1111/ajo.12655] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 05/14/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Kiarash Taghavi
- Department of Paediatric Surgery; Wellington Children's Hospital; Wellington New Zealand
- Department of Paediatrics and Child Health; University of Otago; Wellington New Zealand
| | - Caitlin Sharpe
- School of Medicine; University of Otago; Wellington New Zealand
| | - Mark D. Stringer
- Department of Paediatric Surgery; Wellington Children's Hospital; Wellington New Zealand
- Department of Paediatrics and Child Health; University of Otago; Wellington New Zealand
| | - Jane Zuccollo
- Department of Pathology; Wellington Hospital; Wellington New Zealand
| | - Jay Marlow
- Maternal Fetal Medicine, Women's Health, Obstetrics and Maternity; Wellington Hospital; Wellington New Zealand
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Hamdaoui N, Dabadie A, Lesieur E, Quarello E, Kheiri M, Hery G, Guidicelli B, Bretelle F, Gorincour G. [Ultrasound of the fetal urinary system during the first trimester of pregnancy]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2017; 45:373-380. [PMID: 28552751 DOI: 10.1016/j.gofs.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/02/2017] [Indexed: 12/27/2022]
Abstract
The detection of abnormalities of the fetal urinary system in the first trimester of pregnancy is constantly improving, namely owing to the improved resolution of the image, the use of the endovaginal approach and thanks to sonographers' constant training. The pathological aspects, usually detected in the second trimester of pregnancy, can be suspected early in the first trimester and range from kidneys' cavity dilation to bilateral renal agenesis, polycystic kidney disease, multi-cystic dysplasia and bladder megavessia or bladder exstrophy. A poly-malformative syndrome is to be found out. The detection of an abnormality of the urinary tract requires a close ultrasound check. Very often, the pathological aspects tend to disappear spontaneously. In particular, the non-visualization of the bladder requires repeated examinations during the same session or even a little later in the pregnancy. We will carry out a review of the literature by pointing out the usual and unusual aspects of the fetal urinary system visible in the first trimester and we will as well propose an algorithm describing how to deal with abnormalities of the urinary tract that can be found out at first trimester ultrasound.
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Affiliation(s)
- N Hamdaoui
- Centre de diagnostic prénatal, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France.
| | - A Dabadie
- Service d'imagerie pédiatrique et prénatale, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - E Lesieur
- Centre de diagnostic prénatal, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - E Quarello
- Département d'échographies obstétricales, fondation-hôpital Saint-Joseph, 26, boulevard de Louvain, 13008 Marseille, France; Institut de médecine de la reproduction, 6, rue Rocca, 13008 Marseille, France
| | - M Kheiri
- Service d'imagerie pédiatrique et prénatale, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - G Hery
- Centre de diagnostic prénatal, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France; Service de chirurgie pédiatrique, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - B Guidicelli
- Centre de diagnostic prénatal, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - F Bretelle
- Centre de diagnostic prénatal, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - G Gorincour
- Centre de diagnostic prénatal, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France; Service d'imagerie pédiatrique et prénatale, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
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Abstract
UNLABELLED Fetal megacystis is variably defined and understood. The literature on fetal megacystis was systematically reviewed, focusing on prenatal diagnosis, associations and outcomes. This yielded a total of 18 primary references and eight secondary references. Fetal megacystis has an estimated first-trimester prevalence of between 1:330 and 1:1670, with a male to female ratio of 8:1. In the first trimester, megacystis is most commonly defined as a longitudinal bladder dimension of ≥7 mm. Later in pregnancy, a sagittal dimension (in mm) greater than gestational age (in weeks) + 12 is often accepted. Megacystis can be associated with a thickened bladder wall, which has been objectively defined as >3 mm. Oligohydramnios is present in approximately half of all cases. The most common underlying diagnosis is posterior urethral valves (57%), followed by urethral atresia/stenosis (7%), prune belly syndrome (4%), megacystis-microcolon-intestinal-hypoperistalsis syndrome (MMIHS) (1%), and cloacal anomalies (0.7%). Karyotype anomalies are found in 15%, and include trisomy 18, trisomy 13 and trisomy 21. Ultrasound imaging alone is often insufficient to enable a definitive diagnosis, although it may indicate that a specific diagnosis is more likely. Overall, about 50% of reported fetuses with megacystis are terminated, but this proportion varies considerably between countries and over time. Prognostic stratification is evolving, with the most important factors being oligohydramnios, gestational age at diagnosis, degree of bladder enlargement, renal hyperechogenicity, karyotype, and sex. CONCLUSIONS This review demonstrated some consensus on the ultrasound criteria for defining fetal megacystis, and illustrated the spectrum of pathologies and their relative frequencies that can cause this condition. It also underlined important associated karyotype anomalies. To progress understanding of the natural history of enlarged fetal bladders, more accurate diagnostics are required, and risk stratification needs to be refined to facilitate prenatal counseling.
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21
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Farrugia MK. Fetal bladder outlet obstruction: Embryopathology, in utero intervention and outcome. J Pediatr Urol 2016; 12:296-303. [PMID: 27570093 DOI: 10.1016/j.jpurol.2016.05.047] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/17/2016] [Indexed: 11/17/2022]
Abstract
Fetal bladder outlet obstruction (BOO), most commonly caused by posterior urethral valves (PUV), remains a challenging and multi-faceted condition. Evolving techniques, and refinement in ultrasound, optics and instrumentation, have increased our rate of prenatal diagnosis, and enabled valve ablation not only in smaller newborns, but also in fetuses. Long-term outcome studies have raised our awareness of the silent damage caused by bladder dysfunction and polyuria and encouraged their proactive management. In spite of our best efforts, the proportion of boys with PUV who progress to chronic and end-stage renal disease (ESRD) has not changed in the last 25 years. Evidence suggests a reduction in perinatal mortality following prenatal intervention, probably resulting from amelioration of oligohydramnios at the crucial time of lung development between 16 and 28 weeks' gestation, but no improvement in postnatal renal outcome. There are no bladder functional outcome studies in patients who have undergone prenatal intervention and hence the long-term effect of in utero defunctionalisation of the bladder is not known. This aim of this review is to revisit the embryopathology of fetal BOO, in particular the renal and bladder structural and functional changes that occur with in utero obstruction. The effect of earlier prenatal diagnosis, and therapy, on postnatal outcome is also explored and compared with outcomes published for traditional postnatal treatment.
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Affiliation(s)
- Marie-Klaire Farrugia
- Chelsea Children's Hospital at the Chelsea & Westminster Hospital Foundation Trust, London SW10 9NH, UK.
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22
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De Sousa J, Upadhyay V, Stone P. Megacystis Microcolon Intestinal Hypoperistalsis Syndrome: Case Reports and Discussion of the Literature. Fetal Diagn Ther 2015; 39:152-7. [DOI: 10.1159/000442050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/26/2015] [Indexed: 11/19/2022]
Abstract
Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) is a rare intestinal dysmotility condition that also involves a dilated urinary bladder. It was believed to be an autosomal recessive condition, but genetic studies have suggested possibly an autosomal dominant inheritance pattern. Prenatal diagnosis can be challenging, but MRI and amniotic fluid/digestive fluid studies may be complementary investigations to improve diagnostic accuracy. Prognosis of MMIHS is generally poor and treatment is mostly supportive. To date, bowel transplantation remains the only viable treatment to restore bowel motility. Here we present two additional cases to contribute towards the scant literature on this condition.
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23
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Moaddab A, Sananes N, Hernandez-Ruano S, Werneck Britto IS, Blumenfeld Y, Stoll F, Favre R, Ruano R. Prenatal Diagnosis and Perinatal Outcomes of Congenital Megalourethra: A Multicenter Cohort Study and Systematic Review of the Literature. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:2057-2064. [PMID: 26446816 DOI: 10.7863/ultra.14.12064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 02/21/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the prenatal findings and postnatal outcomes in fetuses with congenital megalourethra. METHODS This retrospective study reviewed our experience and the literature between 1989 and 2014. Prenatal findings were evaluated and compared with postnatal findings, including neonatal mortality and abnormal renal function (need for dialysis or renal transplantation). RESULTS Fifty fetuses with congenital megalourethra were analyzed, including 6 cases diagnosed in our centers. Most cases (n = 43 [86.0%]) were diagnosed in the second trimester. Only 1 case was diagnosed in the first trimester, whereas 6 cases (12.0%) were diagnosed in the third trimester. Thirty-five fetuses (70.0%) survived. Bilateral hydroureters were associated with perinatal death (P= .024). Among the survivors, 41.9% of the neonates had renal impairment. The following factors were associated with postnatal renal impairment: presence of severe oligohydramnios/anhydramnios (P = .033), bilateral hydronephrosis (P = .008), and earlier gestational age at delivery (P = .022). CONCLUSIONS In fetal megalourethra, bilateral hydroureters, bilateral hydronephrosis, and severe oligohydramnios/anhydramnios are associated with neonatal mortality and renal impairment.
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Affiliation(s)
- Amirhossein Moaddab
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Texas Children's Hospital Pavilion for Women, Houston, Texas USA (A.M., I.S.W.B., R.R.); Service de Gynécologie Obstétrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (N.S., F.S., R.F.); Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche-S 1121, Biomatériaux et Bioingénierie, Strasbourg, France (N.S.); Dr Ademir C. Ruano Maternal-Fetal Clinic, São Paulo, Brazil (S.H.-R., R.R.); and Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.B.)
| | - Nicolas Sananes
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Texas Children's Hospital Pavilion for Women, Houston, Texas USA (A.M., I.S.W.B., R.R.); Service de Gynécologie Obstétrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (N.S., F.S., R.F.); Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche-S 1121, Biomatériaux et Bioingénierie, Strasbourg, France (N.S.); Dr Ademir C. Ruano Maternal-Fetal Clinic, São Paulo, Brazil (S.H.-R., R.R.); and Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.B.)
| | - Simone Hernandez-Ruano
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Texas Children's Hospital Pavilion for Women, Houston, Texas USA (A.M., I.S.W.B., R.R.); Service de Gynécologie Obstétrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (N.S., F.S., R.F.); Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche-S 1121, Biomatériaux et Bioingénierie, Strasbourg, France (N.S.); Dr Ademir C. Ruano Maternal-Fetal Clinic, São Paulo, Brazil (S.H.-R., R.R.); and Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.B.)
| | - Ingrid Schwach Werneck Britto
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Texas Children's Hospital Pavilion for Women, Houston, Texas USA (A.M., I.S.W.B., R.R.); Service de Gynécologie Obstétrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (N.S., F.S., R.F.); Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche-S 1121, Biomatériaux et Bioingénierie, Strasbourg, France (N.S.); Dr Ademir C. Ruano Maternal-Fetal Clinic, São Paulo, Brazil (S.H.-R., R.R.); and Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.B.)
| | - Yair Blumenfeld
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Texas Children's Hospital Pavilion for Women, Houston, Texas USA (A.M., I.S.W.B., R.R.); Service de Gynécologie Obstétrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (N.S., F.S., R.F.); Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche-S 1121, Biomatériaux et Bioingénierie, Strasbourg, France (N.S.); Dr Ademir C. Ruano Maternal-Fetal Clinic, São Paulo, Brazil (S.H.-R., R.R.); and Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.B.)
| | - François Stoll
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Texas Children's Hospital Pavilion for Women, Houston, Texas USA (A.M., I.S.W.B., R.R.); Service de Gynécologie Obstétrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (N.S., F.S., R.F.); Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche-S 1121, Biomatériaux et Bioingénierie, Strasbourg, France (N.S.); Dr Ademir C. Ruano Maternal-Fetal Clinic, São Paulo, Brazil (S.H.-R., R.R.); and Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.B.)
| | - Romain Favre
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Texas Children's Hospital Pavilion for Women, Houston, Texas USA (A.M., I.S.W.B., R.R.); Service de Gynécologie Obstétrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (N.S., F.S., R.F.); Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche-S 1121, Biomatériaux et Bioingénierie, Strasbourg, France (N.S.); Dr Ademir C. Ruano Maternal-Fetal Clinic, São Paulo, Brazil (S.H.-R., R.R.); and Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.B.)
| | - Rodrigo Ruano
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Texas Children's Hospital Pavilion for Women, Houston, Texas USA (A.M., I.S.W.B., R.R.); Service de Gynécologie Obstétrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (N.S., F.S., R.F.); Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche-S 1121, Biomatériaux et Bioingénierie, Strasbourg, France (N.S.); Dr Ademir C. Ruano Maternal-Fetal Clinic, São Paulo, Brazil (S.H.-R., R.R.); and Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.B.).
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