1
|
Gutierrez J, Sepulveda W, Ramirez R, Acosta G, Ambiado S. Fetal Bladder Rupture as a Complication of Adjunctive Therapy in Severe Maternal SARS-CoV-2 Pneumonia. Fetal Pediatr Pathol 2022; 41:818-822. [PMID: 34369260 DOI: 10.1080/15513815.2021.1963359] [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] [Indexed: 10/20/2022]
Abstract
INTRODUCTION A case of spontaneous fetal bladder rupture occurring in a woman with SARS-CoV-2 pneumonia receiving invasive ventilatory support is reported. CASE A 33-year-old woman was admitted at 30.6 weeks' gestation with the diagnosis of severe pneumonia due to COVID-19. The patient required invasive mechanical ventilation on day 2. Propofol, fentanyl, midazolam, and dexmedetomidine were administered for sedation, pain relief, and to improve patient-ventilator interaction. A bedside ultrasound on day 3 revealed fetal megacystis. Follow-up scan two days later showed urinary ascites and a collapsed bladder. The diagnosis of fetal bladder rupture was confirmed postpartum. Bladder repair was performed on day 5, with an uneventful recovery. DISCUSSION Transplacental transfer of opioids during invasive ventilatory support in pregnancy may cause acute fetal bladder atony leading to severe urine retention and, potentially, bladder rupture. This can be a serious complication of adjunctive therapy in women with severe SARS-CoV-2 pneumonia.
Collapse
Affiliation(s)
- Jorge Gutierrez
- Department of Obstetrics and Gynecology, Clinica Indisa, Santiago, Chile
| | | | - Raul Ramirez
- Department of Pediatric Urology, Clinica Indisa, Santiago, Chile
| | - Gina Acosta
- Department of Obstetrics and Gynecology, Clinica Indisa, Santiago, Chile
| | - Sergio Ambiado
- Neonatal Intensive Care Unit, Clinica Indisa, Santiago, Chile
| |
Collapse
|
2
|
Norris JJ, Raj JP, Thomas TT, Maleperambil TT, Shubha AM. Effects of oxybutynin in children with posterior urethral valves post fulguration: Report in a select cohort of children. J Family Med Prim Care 2021; 10:3706-3711. [PMID: 34934669 PMCID: PMC8653479 DOI: 10.4103/jfmpc.jfmpc_2554_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 06/27/2021] [Accepted: 07/09/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives: Posterior urethral valves (PUV) is the commonest obstructive uropathy with varied consequences. Though valve fulguration is the treatment of choice, appropriate bladder management modifies outcome and includes rational use of anticholinergics. Here, we aim to evaluate the effects of oxybutynin on the bladder and urinary tract morphology and function. Concurrently, we document adverse effects encountered, patient compliance, and medication adherence. Methods: A retrospective study of children below 5 years of age (2012–2017) post fulguration and on oxybutynin for at least 6 months. Patient demographics, clinical features, renal ultrasound, micturating cystourethrogram, dimercaptosuccinic acid scan, adverse effects, and pill count for medication adherence were collated. Results: 48 children below the age of 5 years were included, and 12 were excluded either due to the presence of concomitant problems or were not on oxybutynin. Of the 36, four were lost to follow-up and one had died due to an unrelated condition. Thus, a total of 31 children were analyzed. At follow-up, 28/31 patients were asymptomatic, two had daytime incontinence, and one had recurrent urinary tract infection. All patients except one have preserved renal function tests. On ultrasonography, hydroureteronephrosis worsened in only 1/25 children and two showed significant post void residues. The resolution of vesicoureteral reflux was noted in almost 50%. 4/31 renal units had progressive scars. Only two parents defaulted medication. Urodynamic study done in half of these children showed stable bladder pressures except in two. Conclusion: Oxybutynin therapy following adequate valve fulguration aids upper tracts preservation by stabilizing deranged bladder dynamics. The medication is well tolerated with minimal or no side effects.
Collapse
Affiliation(s)
| | - Jeffrey Pradeep Raj
- Department of Pharmacology, St. John's Medical College, Bengaluru, Karnataka, India
| | - Tia Teresa Thomas
- Medical Student, St. John's Medical College, Bengaluru, Karnataka, India
| | | | | |
Collapse
|
3
|
Velhal R, Jain A, Nayan A, Patwardhan S, Patil B. Impact of surgical intervention on progression to end-stage renal disease in patients with posterior urethral valve. AFRICAN JOURNAL OF UROLOGY 2021; 27:158. [PMID: 34924751 PMCID: PMC8665853 DOI: 10.1186/s12301-021-00261-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 11/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Posterior urethral valve patients present with varied presentations at any age of life and have significant associated morbidity and require long-term follow-up and care. Methods This was a single-center ambispective cohort study carried out over a period of 2 years. Patient data regarding the symptoms, investigations, interventions, secondary complications were recorded and were followed up regularly during the study till either normalization of their creatinine level which was maintained up to one-year post-fulguration (non-CKD) or progression to end-stage renal disease (ESRD) requiring renal transplant. Various clinical factors were then compared between these groups. Results The age of presentation varies from 6 months antenatal period to a maximum of 34 years. Most common symptom was of lower urinary tract obstruction, followed by recurrent febrile UTI. The interval between disease presentation detection and PU valve fulguration ranged from 6 days to more than 5 years, median duration being 1 month. 85.7% patients had hydroureteronephrosis on initial USG. In VCUG, there was no significant difference found between the presence of reflux and poor renal outcome. Age of presentation greater than 2 years was seen in 52% of patients with CKD compared to only 10% patients in non-CKD group (significant, p value 0.02). Among patients who developed CKD, 60% of patients had PU valve fulguration after one month of disease presentation, while in contrast, among the non-CKD group, 80% of patients had it done within one month of disease presentation. (significant, p value 0.03). Conclusions Late age of presentation, delayed fulguration with high initial creatinine, and failure of serum creatinine to return to normal after one-month post-fulguration are important risk factors in the progression of the disease to ESRD. Symptomatic improvement after interventions does not correlate with progression to ESRD. The number of interventions also does not predict progression to ESRD. Interventions should be chosen wisely on case to restore near-normal physiology and delay progression to ESRD.
Collapse
Affiliation(s)
- Rishikesh Velhal
- Department of Urology, Seth GS Medical College and KEM Hospital, Affiliated to Maharashtra University of Health Sciences, Mumbai, India
| | - Aadhar Jain
- Department of Urology, Seth GS Medical College and KEM Hospital, Affiliated to Maharashtra University of Health Sciences, Mumbai, India
| | - Anveshi Nayan
- Seth GS Medical College and KEM Hospital, Affiliated to Maharashtra University of Health Sciences, Mumbai, India
| | - Sujata Patwardhan
- Department of Urology, Seth GS Medical College and KEM Hospital, Affiliated to Maharashtra University of Health Sciences, Mumbai, India
| | - Bhushan Patil
- Department of Urology, Seth GS Medical College and KEM Hospital, Affiliated to Maharashtra University of Health Sciences, Mumbai, India
| |
Collapse
|
4
|
Sharma D, Tsibizova VI. Current perspective and scope of fetal therapy: part 1. J Matern Fetal Neonatal Med 2020; 35:3783-3811. [PMID: 33135508 DOI: 10.1080/14767058.2020.1839880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Fetal therapy term has been described for any therapeutic intervention either invasive or noninvasive for the purpose of correcting or treating any fetal malformation or condition. Fetal therapy is a rapidly evolving specialty and has gained pace in last two decades and now fetal intervention is being tried in many malformations with rate of success varying with the type of different fetal conditions. The advances in imaging techniques have allowed fetal medicine persons to make earlier and accurate diagnosis of numerous fetal anomalies. Still many fetal anomalies are managed postnatally because the fetal outcomes have not changed significantly with the use of fetal therapy and this approach avoids unnecessary maternal risk secondary to inutero intervention. The short-term maternal risk associated with fetal surgery includes preterm labor, premature rupture of membranes, uterine wall bleeding, chorioamniotic separation, placental abruption, chorioamnionitis, and anesthesia risk. Whereas, maternal long-term complications include risk of infertility, uterine rupture, and need for cesarean section in future pregnancies. The decision for invasive fetal therapy should be taken after discussion with parents about the various aspects like postnatal fetal outcome without fetal intervention, possible outcome if the fetal intervention is done, available postnatal intervention for the fetal condition, and possible short-term and long-term maternal complications. The center where fetal intervention is done should have facility of multi-disciplinary team to manage both maternal and fetal complications. The major issues in the development of fetal surgery include selection of patient for intervention, crafting effective fetal surgical skills, requirement of regular fetal and uterine monitoring, effective tocolysis, and minimizing fetal and maternal fetal risks. This review will cover the surgical or invasive aspect of fetal therapy with available evidence and will highlight the progress made in the management of fetal malformations in last two decades.
Collapse
Affiliation(s)
- Deepak Sharma
- Department of Neonatology, National Institute of Medical Science, Jaipur, India
| | - Valentina I Tsibizova
- Almazov National Medical Research Centre, Health Ministry of Russian Federation, Saint Petersburg, Russia
| |
Collapse
|
5
|
Gaibie Z, Mahomed N, Petersen KL, Moonsamy G, Bokhari AAH, Adam A. Can the posterior:anterior urethral ratio on voiding cystourethrogram be used as a reliable predictor of successful posterior urethral valve ablation in male children? SA J Radiol 2020; 24:1820. [PMID: 32670630 PMCID: PMC7343929 DOI: 10.4102/sajr.v24i1.1820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/18/2020] [Indexed: 11/15/2022] Open
Abstract
Background The role of the voiding cystourethrogram (VCUG) in the follow-up of children with posterior urethral valves (PUVs) post-ablation has been considered a standard practice. The urethral ratio and gradient of change have proven to be useful. Objectives We aimed to review the role of the ‘ideal’ ratio on predicting residual PUV post-ablation. Methods A systematic review of the PubMed, SCOPUS and Web of Science databases was performed (April 2019). The search terms included ‘Urethral Ratio and Posterior urethral valve ablation’. All cited reference lists were further evaluated for additional inclusive studies. Results Eleven studies were identified, of which nine were relevant to the topic. Case reports, comments and adult and animal studies were excluded, leaving four studies for critical review. In total, 338 patients were assessed. The control group consisted of 167 age-matched, male children. Study regions included India and Australia. The ages ranged from 15 days to 3.4 years. Ablation methods included the use of a resectoscope with cutting diathermy, cold knife or Bugbee electrode. The mean urethral ratios in the control group ranged from 1.04 to 1.73. The suggested predictive urethral cut-off ratios recommended include 2.2 (p = 0.001), 2.5–3 and 3.5. Conclusion Although the precise cut-off ratio could not be clearly defined in this review, a urethral ratio less than a range of 2.2–3.5 has proven to be a beneficial predictor of ablation success and should thus be incorporated into standard VCUG reporting templates in the follow-up of PUVs in male children in resource-limited settings.
Collapse
Affiliation(s)
- Zakiyah Gaibie
- Division of Urology, Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Urology, Helen Joseph Hospital, Johannesburg, South Africa.,Department of Paediatric Urology, Rahima Moose Mother and Child Hospital, Johannesburg, South Africa
| | - Nasreen Mahomed
- Department of Radiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen L Petersen
- Division of Paediatric Nephrology, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatric Nephrology, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Glenda Moonsamy
- Division of Paediatric Nephrology, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatric Nephrology, Charlotte Maxeke Academic Hospital, Johannesburg, South Africa
| | - Akram A H Bokhari
- Division of Urology, Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Urology, Helen Joseph Hospital, Johannesburg, South Africa.,Department of Paediatric Urology, Rahima Moose Mother and Child Hospital, Johannesburg, South Africa.,Department of Urology, College of Medicine, Hail University, Hail, Saudi Arabia.,Department of Urology, King Fahad General Hospital, Jeddah, Saudi Arabia
| | - Ahmed Adam
- Division of Urology, Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Urology, Helen Joseph Hospital, Johannesburg, South Africa.,Department of Paediatric Urology, Rahima Moose Mother and Child Hospital, Johannesburg, South Africa
| |
Collapse
|
6
|
Mallya A, Karthikeyan VS, Vijayganapathy S, Poonawala A, Keshavamurthy R. Urodynamic profile in posterior urethral valve patients following fulguration: Does age at fulguration matter? Indian J Urol 2018; 34:278-282. [PMID: 30337783 PMCID: PMC6174714 DOI: 10.4103/iju.iju_148_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Children with posterior urethral valve (PUV) may develop urinary bladder (UB) dysfunction even after valve fulguration (VF). Using Urodynamics (UDS), we sought to identify whether age at VF and time elapsed since VF contributed to UB dysfunction. Materials and Methods: Between January 2009 and July 2016, 39 PUV patients referred to a tertiary care center for UDS were classified into Groups A and B (based on age if <2 or ≥2 years at VF) and subclassified into Group A1/A2 and B1/B2 depending on time duration after VF (TVU). A1 and B1 constituted TVU ≤4 years and A2 and B2 constituted TVU >4 years, respectively. Results: Median (range) ages at VF and UDS were 18 (1–108) months and 9 (1–19) years. Median (range) time between VF and UDS was 60 (6–164) months. Reduced compliance was seen in 67%, detrusor overactivity in 38.5%, and leak in 15.4% boys, respectively. Median (range) Qmax was 8 (0–28) ml/s and 25% boys had hypocontractile detrusor at voiding. Statistically significant reduction was found in compliance when comparing Group B versus Group A (P = 0.037) and in bladder capacity (P = 0.002) and compliance (P = 0.043) in Group A2 versus A1. Conclusions: Boys with VF at <2 years had better urodynamic profiles than those with fulguration over 2 years of age. As the time period since fulguration increased, there was a higher incidence of bladder dysfunction in both the groups.
Collapse
Affiliation(s)
- Ashwin Mallya
- Department of Urology, Institute of Nephro Urology, Bengaluru, Karnataka, India
| | | | | | - Ali Poonawala
- Department of Urology, Institute of Nephro Urology, Bengaluru, Karnataka, India
| | | |
Collapse
|
7
|
Quintero RA, Gomez Castro LA, Bermudez C, Chmait RH, Kontopoulos EV. In utero management of fetal lower urinary tract obstruction with a novel shunt: a landmark development in fetal therapy. J Matern Fetal Neonatal Med 2010; 23:806-12. [PMID: 19968590 DOI: 10.3109/14767050903443491] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Fetal lower urinary tract obstruction occurs in approximately 1:3000 pregnancies. Standard vesicoamniotic shunting is fraught with malfunctioning in upto 60% of cases. We hereby report the development and application of a novel and reliable shunt. MATERIALS AND METHODS Patients with lower urinary tract obstruction were offered the novel shunt among other standard management options. Shunting involved the placement of a double disk device with a standard double pig-tail catheter. All patients signed informed consent. RESULTS Four patients have been treated with the novel shunt. In three patients, shunting was conducted between the bladder and amniotic cavity. In one patient (dichorionic-discordant twins) with a prior dislodged shunt causing urinary ascites, shunting was conducted between the peritoneal and amniotic cavities ('bridge shunt'). In all cases, correct and stable shunt placement was confirmed endoscopically and sonographically and in all patients, the fetal bladder remains effectively drained. CONCLUSION Reliable and effective vesico or peritoneoamniotic shunting can be achieved with the novel shunt. This shunt cannot become dislodged into the peritoneal cavity or the amniotic cavity, and cannot be pulled out by the fetus. Further experience is necessary to determine the risks and benefits of this novel treatment for fetal lower urinary tract obstruction.
Collapse
Affiliation(s)
- Ruben A Quintero
- Department of Obstetrics and Gynecology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
| | | | | | | | | |
Collapse
|
8
|
Calhoun BC. The fetus as our patient: the confluence of faith and science in the care of the unborn. LINACRE QUARTERLY 2005; 72:189-211. [PMID: 16317844 DOI: 10.1080/20508549.2005.11877751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
9
|
Abstract
Fetal surgery is now an accepted modality for treatment of a variety of lethal and non-lethal congenital conditions. It represents a new, fast-moving frontier of medicine in which cooperative mulitdisciplinary effort and input are required to assure both fetal and maternal welfare. A wide range of therapeutic strategies from percutaneous to open invasive techniques has led to a complex list of different procedures for different diseases. This review identifies the most common disease entities managed by fetal intervention, examines the evolution in development of techniques to those currently used, and describes the prospective, randomized trials presently underway that are designed to establish the safety and determine true efficacy of treatment. Fetal surgery as a (multi)discipline continues to strive to minimize maternal and fetal risk. Undoubtedly, as tocolytic therapy and neonatal intensive efforts improve, fetal therapy will expand.
Collapse
Affiliation(s)
- Raul A Cortes
- Division of Pediatric Surgery, The Fetal Treatment Center, University of California, San Frncisrco, CA 94143-0570, USA
| | | |
Collapse
|
10
|
Abstract
Several advances have been made in the field of fetal medicine since the last BMJ review on the subject. This review covers advances in prenatal screening, imaging techniques, management of multiple pregnancies, and fetal therapy
Collapse
Affiliation(s)
- Sailesh Kumar
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College London, Du Cane Road, London W12 0HS.
| | | |
Collapse
|