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Partridge EA, Canning D, Long C, Peranteau WH, Hedrick HL, Adzick NS, Flake AW. Urologic and anorectal complications of sacrococcygeal teratomas: prenatal and postnatal predictors. J Pediatr Surg 2014; 49:139-42; discussion 142-3. [PMID: 24439598 DOI: 10.1016/j.jpedsurg.2013.09.042] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 09/30/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE Anorectal and urologic sequelae are observed in long-term survivors of sacrococcygeal teratoma (SCT). In this study we evaluate the incidence and predictors of anorectal and urologic complications in SCT. METHODS A retrospective review was performed for all SCT patients who underwent resection at a single institution between 2000 and 2012. Enrollment criteria included a minimum of 12months follow-up. Categorical variables were analyzed by Fisher's exact test and continuous variables by Mann Whitney test (p<0.05). RESULTS Forty-five patients were studied. Anorectal complications occurred in 29%, including severe chronic constipation (n=13) and fecal incontinence (n=4). Urologic complications occurred in 33%, including neurogenic bladder (n=12), vesicoureteral reflux (n=5), and urinary incontinence (n=7). Prenatal imaging by fetal MRI demonstrated mass effect with obstruction of the bowel (n=4) or bladder and collecting system (n=7) in a subset of patients with postnatal complications (anorectal 4/4, PPV 100%; urologic 6/7, PPV 86%). Postnatal complications were associated with obstructive findings on prenatal imaging, prenatal therapeutic interventions, Altman classification, perineal reconstruction, and tumor recurrence. No anorectal or urologic complications occurred in patients with Altman type I tumors. CONCLUSIONS Urologic and anorectal complications are common in patients with SCT. Higher Altman classification and prenatal imaging suggestive of intestinal or urologic obstruction should prompt focused prenatal counseling and postnatal screening for anorectal and urologic dysfunction.
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Affiliation(s)
- Emily A Partridge
- The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia PA
| | - Douglas Canning
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia PA
| | - Christopher Long
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia PA
| | - William H Peranteau
- The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia PA
| | - Holly L Hedrick
- The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia PA
| | - N Scott Adzick
- The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia PA
| | - Alan W Flake
- The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia PA.
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Karnak I, Atilla P, Müftüoğlu S. Effect of increased intra-abdominal pressure on urinary system development in fetal rabbits. J Pediatr Urol 2012; 8:535-43. [PMID: 22099478 DOI: 10.1016/j.jpurol.2011.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Accepted: 09/12/2011] [Indexed: 01/15/2023]
Abstract
AIM To investigate the effect of increased intra-abdominal pressure (IAP) on the fetal urinary system. MATERIALS AND METHODS Pregnant rabbits (15-day gestation) were used. Control (n = 5) and experimental (EG, n = 4) groups underwent intraperitoneal catheter placement. The IAP was increased by intraperitoneal air insufflations during the third trimester in the EG. At term, organ weight and organ weight/body weight (BW) ratios were noted, histological examination of the urinary system organs was performed, and the apoptotic indexes were calculated. RESULTS BW and total renal weight were significantly increased in the EG (38.65 ± 8.34 g vs 49.36 ± 8.81 g, p = 0.008; and 0.406 ± 0.132 g vs 0.531 ± 0.129 g, p = 0.02). Total renal weight/BW ratio did not differ between groups (0.0103 ± 0.001 vs 0.0107 ± 0.001; p = 0.33). Bladder weight and bladder weight/BW ratio was also significantly increased in the EG (0.067 ± 0.014 g vs 0.114 ± 0.026 g, p = 0.00; and 0.00175 ± 0.00026 vs 0.00229 ± 0.00036, p = 0.001). Immature glomeruli and collecting tubules, and a thin and underdeveloped muscular layer in the ureter and bladder were encountered in the EG, and the apoptotic cell index was significantly increased (p < 0.05). CONCLUSION Increased IAP has an adverse effect on fetal urinary system development, and may play a role in the pathogenesis of various congenital abnormalities of the urinary system.
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Affiliation(s)
- Ibrahim Karnak
- Hacettepe University Faculty of Medicine, Departments of Pediatric Surgery, 06100 Sıhhiye, Ankara, Turkey.
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Abstract
Urinary tract obstruction results in obstructive nephropathy and uropathy. It is the most frequent cause of renal failure in infants and children. In the past two decades studies of transgenic models and humans have greatly enhanced our understanding of the genetic factors and developmental processes important in urinary tract obstruction. The emerging picture is that development of the urinary tract requires precise integration of a variety of progenitor cell populations of different embryonic origins. Such integration is controlled by an intricate signaling network that undergoes dynamic changes as the embryo develops. Most congenital forms of urinary tract obstruction result from the disruption of diverse factors and genetic pathways involved in these processes, especially in the morphogenesis of the urinary conduit or the functional aspects of the pyeloureteral peristaltic machinery.
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Affiliation(s)
- Feng Chen
- Renal Division, Department of Internal Medicine, Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Affiliation(s)
- M Whittle
- University of Birmingham, Birmingham, UK.
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Abstract
Although clinical outcome data on fetuses with oligohydramnios of renal origin are scarce, prognosis is regarded as poor due to a high risk of renal dysfunction and pulmonary hypoplasia. This review aims to summarize the current knowledge and clinical experience with patients presenting antenatally with renal oligohydramnios. By reviewing the underlying mechanisms, complications, and outcome data, we hope to further improve antenatal counseling and postnatal care. We conclude that prognosis of ROH has changed in recent years. While early data before the introduction of sophisticated neonatal intensive care and renal replacement therapy indicated a poor prognosis, nowadays, a much more optimistic prognosis of children after renal oligohydramnios can be expected from the recent publications in the literature.
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Affiliation(s)
- Markus J Kemper
- Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Abstract
OBJECTIVE Antenatal hydronephrosis is diagnosed in 1% to 5% of all pregnancies; however, the antenatal and postnatal management of hydronephrosis varies widely. No previous studies define the risk of postnatal pathology in infants with antenatal hydronephrosis. Our objective was to review the current literature to determine whether the degree of antenatal hydronephrosis and related antenatal ultrasound findings are associated with postnatal outcome. METHODS We searched Medline (1966-2005), Embase (1991-2004), and the Cochrane Library databases for articles on antenatal hydronephrosis. We required studies to have subjects selected on the basis of documented measurements of antenatal hydronephrosis and followed to a postnatal diagnosis. We excluded case reports, review articles, and editorials. Two independent investigators extracted data. RESULTS We screened 1645 citations, of which 17 studies met inclusion criteria. We created a data set of 1308 subjects. The risk of any postnatal pathology per degree of antenatal hydronephrosis was 11.9% for mild, 45.1% for moderate, and 88.3% for severe. There was a significant increase in risk per increasing degree of hydronephrosis. The risk of vesicoureteral reflux was similar for all degrees of antenatal hydronephrosis. CONCLUSIONS The findings of this meta-analysis can potentially be used for prenatal counseling and may alter current postnatal management of children with antenatal hydronephrosis. Overall, children with any degree of antenatal hydronephrosis are at greater risk of postnatal pathology as compared with the normal population. Moderate and severe antenatal hydronephrosis have a significant risk of postnatal pathology, indicating that comprehensive postnatal diagnostic management should be performed. Mild antenatal hydronephrosis may carry a risk for postnatal pathology, but additional prospective studies are needed to determine the optimal management of these children. A well-defined prospective analysis is needed to further define the risk of pathology and the appropriate management protocols.
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Affiliation(s)
- Richard S Lee
- Children's Hospital Boston, Department of Urology, 300 Longwood Ave, Hunn-390, Boston, Massachusetts 02115, USA.
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Bulla M, Kuwertz-Bröking E, Fründ S, Schulze Everding A, Louwen F, Baez E, Steinhard J, Brinkmann O, August C, Harms E, Hertle L, Kiesel L. Fetale Nephro-/Uropathien: Retrospektive Analyse von 124 Fällen, erfasst im Zeitraum von 1996 bis 2002. Z Geburtshilfe Neonatol 2005; 209:100-7. [PMID: 15995942 DOI: 10.1055/s-2005-871219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The embryological development of the kidneys and the urinary tract follows a complex choreography. Disorders are quite common. The incidence of disorders amounts to 0.3 - 0.8 % of live-born infants. In addition, several chromosomal anomalies are combined with renal malformations. The poor prognosis of some of these diseases is reflected in a perinatal mortality of 6.3 %. PATIENTS AND METHODS Retrospectively 124 cases with fetal nephro-/uropathy detected by prenatal ultrasonography between 1996 and 2002 were analyzed. Features of hypo-dysplastic kidneys (uni- or bilateral) were seen in 21 cases. Multicystic kidney disease (uni- or bilateral) existed in 40 fetuses. In some cases of multicystic or dysplastic kidney diseases, extrarenal malformations were combined. 21 fetuses suffered from autosomal recessive polycystic kidney disease. 18 male unborns showed the typical picture of intravesical obstruction due to posterior uretheral valves. The prune belly syndrome was seen 4 times. Hydronephrotic kidneys with more than 5 mm pelvic dilatation were detected in 13 cases. Renal agenesis led to a lethal outcome perinatally in 5 cases. One child died of bilateral thrombosis of renal artery and venous system. RESULTS The high incidence of diseases with a poor prognosis accounts for the high mortality of 50.8 % (intrauterine or postnatal death, induced abortion). Such a fatal outcome was observed in autosomal recessive polycystic kidney disease, bilateral multicystic dysplastic kidney disease, bilateral renal dysplasia combined with severe extrarenal malformations, intravesical obstruction, renal agenesis and bilateral thrombosis of the renal vessels. Only 60 children survived. Of these 26 needed urological surgery. 15 suffered from progressive renal insufficiency. During a follow-up of 8 - 58 months only 44 exhibited a normal renal function. CONCLUSIONS Such complex renal and urological diseases in the fetus require an interdisciplinary management of the pregnancy.
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Affiliation(s)
- M Bulla
- Pädiatrische Nephrologie, Universität Münster, Deutschland.
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Miguelez J, Bunduki V, Yoshizaki CT, Sadek LDSR, Koch V, Peralta CFA, Zugaib M. Fetal obstructive uropathy: is urine sampling useful for prenatal counselling? Prenat Diagn 2005; 26:81-4. [PMID: 16374901 DOI: 10.1002/pd.1360] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To evaluate whether fetal urinary sodium and chloride provide clinically useful information in addition to ultrasound in bilateral obstructive uropathy. METHODS Sonographic features and urinary concentrations of sodium and chloride were evaluated in fetuses with bilateral obstructive uropathy. After a minimum of 12 months of postnatal follow-up, cases that developed increased serum creatinine (greater than 50 micromol/L) were compared with those that did not. RESULTS Of the cases studied, 16/35 died perinatally, all showing anamnios and markedly elevated urinary electrolytes. Of the survivors, ten maintained normal postnatal serum creatinine, whereas nine did not. The frequency of reduced amniotic fluid/olygohydramnios was higher in cases that developed increased serum creatinine (four out of nine) than in those that did not (nil). Sodium above the 95th percentile was 100% specific and 44% sensitive to predict an increased serum creatinine during early infancy, while chloride above the 95th percentile was 70% specific and 56% sensitive. All seven cases in which urinary sodium was elevated and/or amniotic fluid volume was reduced developed renal failure. CONCLUSION Urine sampling slightly improved renal function prediction, but this must be balanced against its fetal risks.
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Affiliation(s)
- Javier Miguelez
- Department of Obstetrics and Gynecology, University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil
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Sahinoglu Z, Mulayim B, Ozden S, Etker S, Celayir A, Ozkan F, Bilgic R. The prenatal diagnosis of cloacal dysgenesis sequence in six cases: can the termination of pregnancy always be the first choice? Prenat Diagn 2004; 24:10-6. [PMID: 14755402 DOI: 10.1002/pd.768] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Cloacal dysgenesis sequence is a lethal malformation, which usually requires termination. In this study, our aim was to evaluate the prenatal and postnatal diagnostic features of cloacal dysgenesis sequence and review the management of the patients. MATERIAL AND METHODS The data of six cases of cloacal dysgenesis sequences were collected from the ultrasonography and neonatal records. The findings were evaluated in prenatal and postnatal periods. Chromosomal analysis was performed in all the cases. The evaluation of primary and secondary malformations was done. Coexisting anomalies were searched for by radiology and histopathology. RESULTS Malformations in six cases (two females and four males) were described. The absence of anal, genital, and urinary openings with intact perineum covered by smooth skin were common findings. These features were considered as primary malformations for cloacal dysgenesis sequence. Secondary anomalies (urinary and gastrointestinal system malformations, pulmonary hypoplasia, and other coexisting anomalies) were evaluated. CONCLUSION The prenatal differential diagnosis of cloacal dysgenesis sequence from other urinary obstructive diseases was essential regarding fetal prognosis, prenatal, and neonatal management. The bladder outlet obstruction and pulmonary hypoplasia due to reduced amniotic fluid and/or kidney disease were considered prognostic factors for neonatal death. Termination of pregnancy is almost always recommended instead of intrauterine shunt procedures; but if we take into consideration one of our cases and a few reported cases who survived in the neonatal period, the prenatal management of these pregnancies needs to be reevaluated.
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Affiliation(s)
- Zeki Sahinoglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children Diseases Education und Research Hospital, Uskudar, Istanbul, Turkey.
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Abstract
Renal dysplasia is the major cause of chronic renal failure in children, and is commonly associated with urinary tract obstruction. There are two phenotypes of renal dysplasia associated with urinary tract abnormality, multicystic dysplastic kidney (MCDK) and obstructive dysplasia (ORD). Previous observations by Potter and co-workers suggested that cystic dilatation of the ureteric bud ampula was the cause of renal dysplasia. In this context, our recent investigation of human fetal dysplastic kidneys provided an alternative explanation for the evolution of renal dysplasia. We suggested that in utero urinary tract obstruction may cause urine retention in functioning nephrons and lead to glomerular cysts in the nephrogenic zone. The mechanism was common to MCDK and ORD, albeit at different sites of obstruction. Expansion of glomerular cysts with tubular dilatation (cysts) disturbs the subsequent nephron induction and may contribute to the abnormal development of fetal kidneys.
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Affiliation(s)
- Michio Nagata
- Department of Pathology, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan
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Lopez C, Faure JM, Deschamps F, Boulot P, Averous M. [Role of fetal urine sampling in the prenatal diagnosis of malformative uropathies]. Prog Urol 2002; 12:1261-7. [PMID: 12545635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE To define the diagnostic and therapeutic value of foetal urine sampling (FUS). MATERIAL AND METHOD Between 1996 and 2001, FUS was performed in 16 patients for three indications: assessment of renal function (Group 1, n = 12), diagnosis of a cystic mass (Group 2, n = 2), prevention of dystocia (Group 3, n = 2). The anomaly was detected by ultrasound. Urine was aspirated from the two renal pelves and/or bladder, or the cystic mass in the other cases. b2-microglobulin and urinary sodium were assayed and karyotyping was performed at the same time. RESULTS 20 FUS were performed In 4 cases, two samples were taken at an interval of 2 weeks. No complications were observed. Group 1: 9 pregnancies were terminated for potential renal failure (6 posterior urethral valves (PUV), 1 Prune Belly syndrome, 2 cases of recessive polycystic kidney disease (PKD). Three pregnancies were continued for 2 foetuses with normal renal function (1 PUV, 1 ureterocele) and one foetus died with severe renal failure (bilateral hydronephrosis). Group 2: one termination of pregnancy was performed in a case of hepatic cyst with portobiliary dysplasia and a giant bladder diverticulum was operated. Group 3: in both cases, evacuating aspiration allowed normal delivery of one live infant (left polycystic dysplasia), and one neonatal death from megabladder-megacolon syndrome. DISCUSSION The value of FUS is controversial. We usually performed this examination for assessment of renal function. The results of FUS are useful for management decisions when they are in favour of potential impaired renal function. They usually confirmed the ultrasound results that already indicated a poor prognosis and they did not change the decision already based on ultrasound findings in any of our cases. For the diagnosis of cystic masses, after drainage of the mass, FUS facilitated investigation of the urinary tract and adjacent organs. When FUS was performed during labour, it reduced the size of the mass and the abdomen, allowing vaginal delivery with a better ventilatory adaptation of the infant.
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Abstract
Fetal uropathies can be identified by obstetric ultrasound (US) examination, permitting treatment before their clinical manifestation. To evaluate the justification for prenatal US screening for urinary-tract malformations (UTM), the outcome of occult UTMs in 23,000 babies born in our hospital between 1992 and 1998 was examined retrospectively. A prenatal US examination was performed on 19,400 newborns; 128 (0.7%) had an abnormal urinary tract, leading to surgery in 38 cases. The overall incidence of UTMs requiring either medical or surgical therapy was 0.2% (45:19,400); 3,600 pregnancies were not screened by prenatal US. To date, 7 of the newborns have presented with urosepsis (2 with renal impairment) and 2 additional case of posterior urethral valves were identified by routine postnatal US. The incidence of significant UTMs was similar in both groups, but complications occurred in the unscreened group. Prenatal US to detect occult UTMs is thus beneficial, fulfilling the criteria for a population-screening test. We recommend postnatal US urinary-tract screening for newborns with no prenatal US examination.
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Affiliation(s)
- Enaam Raboei
- Department of Pediatric Surgery, King Fahd Armed Forces Hospital, P.O. Box 9862, 21159 Jeddah, Saudi Arabia
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Abstract
Glomerular cysts can exist in the context of several different kidney diseases. Advances in the last few years have begun to unravel the genetic bases and pathogenesis of some of these entities, many of which have an origin in abnormal development. In this review, we highlight recent insights into three types of disease associated with glomerular cysts: (1) mutations of the hepatocyte nuclear factor 1beta (HNF-1beta)in the recently described renal cysts and diabetes syndrome, (2) mutations of OFD1in the oral facial digital syndrome type 1 and (3) the role of fetal urinary tract obstruction.
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Affiliation(s)
- Adrian S Woolf
- Nephro-Urology Unit, Room 219, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.
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Weisgerber G. [Pediatric consequences of prenatal diagnosis: uropathies]. Arch Pediatr 2000; 6 Suppl 2:241s-242s. [PMID: 10370494 DOI: 10.1016/s0929-693x(99)80426-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- G Weisgerber
- Service de chirurgie pédiatrique viscérale, Hôpital Robert-Debré, Paris, France
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Cacciari A, Ruggeri G. [Relationship between prenatal and postnatal echographic diagnosis of uropathy: is mass screening useful?]. Arch Ital Urol Androl 1996; 68:13-7. [PMID: 9162344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Urinary tract malformations have a 1-2% incidence. An early diagnosis of these defects allows to realize as fast as possible the best medical and/or surgical treatment, preventing or at least slowing down the evolution toward chronic renal failure. Urinary tract malformations are particularly suitable for a "prevention" program due to their elevated incidence, to the "silent period" preceding complications and to the therapeutic possibilities strictly related to an early diagnosis. Ultrasound screening can easily identify congenital urinary tract abnormalities, especially obstructive ones, but unfortunately almost half of the cases escape even the most expert "eye". It is necessary a complete check-up right after birth. We tried to compare the method and the results of prenatal screening with the postnatal one, already used in many hospitals. We believe, even following our experience, that the screening for urinary tract malformations of all the neonatal population is a goal to pursue and achieve as soon as possible for its high sensitivity and specificity.
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Affiliation(s)
- A Cacciari
- Clinica Chirurgica Pediatrica, Università degli Studi di Bologna
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Abstract
Congenital megalourethra is a rare genital anomaly characterized by dilatation of the penile urethra without evidence of distal obstruction. Reports of the prenatal diagnosis of this condition in the literature are limited. We present a case of congenital megalourethra with obstructive uropathy from the posterior urethra diagnosed prenatally at 18 weeks of gestation. 'Prune-belly'-like features, colonic malrotation, and imperforate anus were also found on autopsy.
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Affiliation(s)
- M H Wu
- Department of Obstetrics and Gynecology, National Cheng-Kung University Hospital, Tainan, Taiwan, R.O.C
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Skupski DW, Eddleman KA, Zellers N, Ward BE. Rapid exclusion of chromosomal aneuploidies by fluorescence in situ hybridization prior to fetal surgery for obstructive uropathy--a case report. Fetal Diagn Ther 1994; 9:353-6. [PMID: 7818786 DOI: 10.1159/000263961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Ultrasound of a fetus at 17 weeks gestation revealed posterior urethral valve syndrome with anhydramnios. Fluorescence in situ hybridization (FISH) to detect aneuploidies of chromosomes 13, 18, 21, X and Y was performed on transitional cells from the fetal bladder obtained at percutaneous vesicocentesis, followed by conventional cytogenetics. Fetal urine was chosen due to unavailability of amniotic fluid for karyotypic analysis. A nonlethal (disomic) karyotype was suggested by FISH, and thus placement of a vesicoamniotic shunt was performed. The ability to prognosticate in cases of obstructive uropathy is not absolute, and fetal surgery for relief of urinary obstruction is best performed at the earliest possible gestational age. Thus, all available means for rapidly ruling out lethal congenital anomalies should be undertaken in cases of obstructive uropathy prior to any decision regarding fetal surgery.
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Affiliation(s)
- D W Skupski
- Division of Maternal-Fetal Medicine, Cornell University Medical Center, New York, N.Y. 10021
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Gasser B, Mauss Y, Ghnassia JP, Favre R, Kohler M, Yu O, Vonesch JL. A quantitative study of normal nephrogenesis in the human fetus: its implication in the natural history of kidney changes due to low obstructive uropathies. Fetal Diagn Ther 1993; 8:371-84. [PMID: 8286028 DOI: 10.1159/000263855] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
An evaluation of nephrogenesis according to fetal age was performed by quantifying the state of the nephrogenic blastema (NB) and the number of glomeruli (GN) on frontal renal sections in 99 control fetuses (gestational age ranging from 9 to 40 weeks) and in 17 aborted fetuses with low urinary tract obstruction (gestational age ranging from 14 to 36 weeks). In the control group, GN increases slowly from the 10th to the 18th week, then abruptly from the 18th to the 32nd week, reaching an upper limit with NB disappearance by the 32nd week. In the uropathy group, the renal changes show a wide range of severity clearly accounted for by the impairment of both NB and GN. The dysplastic effect of urinary backpressure is the more consistent pathogeny with the spectrum of observed renal changes. It is likely, from GN used as a time-dependent marker of renal development, that the most severe dysplasia is the result of early obstruction with abnormal disappearance of NB and subsequent arrest of nephrogenesis.
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Affiliation(s)
- B Gasser
- Institut de Pathologie, URA 1173 du CNRS, Faculté de Médecine ULP, Strasbourg, France
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Abstract
A large contained urinoma measuring 12 x 8 x 8 cm3 was diagnosed in the left kidney of a female fetus at 28 weeks gestation. Analysis of fluid from serial punctures of the cyst indicated that renal function on that side was poor, but because ultrasound findings of the thorax suggested lung growth impairment, a shunt was inserted. After 3 weeks the shunt dislocated into the fetal abdominal cavity and urinous ascites developed. The ascites was found to have resolved spontaneously on ultrasonography 3 weeks later. The infant was delivered at 37 weeks gestation and appeared normal except for bilateral pelvi-ureteric obstruction. This was much worse in the left kidney, the renal function of which was only 10% of normal. A left nephrectomy was carried out when the infant was 6 months old, when the inner part of the shunt was discovered in perinephric fibrous tissue. The renal pelvis was greatly enlarged and fibrotic; no site of rupture could be identified. The infant's respiratory function was normal. This case suggests the use of intrauterine shunting to decompress a large unilateral urinoma resulting in marked elevation of the fetal diaphragm to prevent impairment of fetal lung growth.
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Affiliation(s)
- R Zimmermann
- Department of Obstetrics, University of Zurich, Switzerland
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21
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Abstract
In 60 fetuses with obstructive uropathy, sodium, total calcium, urea, and creatinine were measured in samples obtained by "urodochocentesis" or pyelocentesis at 16 to 36 weeks' gestation. The patients were retrospectively assigned into two groups on the basis of outcome. Group 1 (n = 20) included infants who either had normal postnatal renal function or absence of prenatal renal dysplasia. Group 2 included infants who either had histologic evidence of renal dysplasia or subsequently developed renal failure. In group 1 the urinary sodium decreased and creatinine increased with gestation, demonstrating maturation in fetal renal function. In group 2 the urinary sodium and calcium were higher and the urinary urea and creatinine were lower than in group 1. The best predictor of outcome was the combination of either high calcium or high sodium with a positive predictive value of 91.3% and negative predictive value of 77.7%. In the antenatal evaluation of obstructive uropathy, fetal urinary biochemistry provides useful information for more accurate counseling of the parents and a rational basis for selecting patients who may benefit from intrauterine therapeutic interventions.
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Affiliation(s)
- K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital School of Medicine, London, England
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Abstract
Vesicoamniotic shunting for fetal obstructive uropathy is beneficial in selected cases. We report a new complication, fetal abdominal wall defect secondary to vesicoamniotic shunting. Placement of the shunt should be as low and as close to the fetal midline as possible in order to reduce the risk of this complication.
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Affiliation(s)
- A G Robichaux
- Department of Obstetrics and Gynecology, Ochsner Clinic, New Orleans, La
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Mandelbrot L, Dumez Y, Muller F, Dommergues M. Prenatal prediction of renal function in fetal obstructive uropathies. J Perinat Med 1991; 19 Suppl 1:283-7. [PMID: 1779372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Affiliation(s)
- D F Thomas
- Department of Paediatric Surgery, St James's University Hospital, Leeds
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Harpaz N, Gellman E. Urogenital mesenteric cyst with fallopian tubal features. Arch Pathol Lab Med 1987; 111:78-80. [PMID: 3800609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Urogenital cysts are retroperitoneal or mesenteric cysts that are derived from vestigial remnants of the embryonic urogenital apparatus. Although their precise embryonic origins are usually obscure, occasionally they display histologic features indicative of a mesonephric or metanephric origin. This report describes an unusual mesenteric müllerian cyst consisting of an endosalpingial lining and two-layered smooth muscle walls, probably representing a müllerian duct duplication cyst.
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Duval JM, Milon J, Coadou Y, Blouet JM, Langella B, Bourgin T, Nicolas JC, Fremond B, Duval JC, Jouan H. Ultrasonographic anatomy and diagnosis of fetal uropathies affecting the upper urinary tract. I. Obstructive uropathies. Anat Clin 1985; 7:301-32. [PMID: 3914309 DOI: 10.1007/bf01784646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The authors describe the ultrasonographic anatomy and semiology of allowing detection of the main types of fetal uropathies. The results of the author's personal experience in this domain are compared to data from the literature. Differential features of the uropathies are given and the limitations and practical significance of prenatal and postnatal ultrasonography are discussed.
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27
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Federman DD. The articulations of Adam's rib with the lower urinary tract. Kidney Int 1984; 26:476-81. [PMID: 6527474 DOI: 10.1038/ki.1984.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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28
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Coleman JW, Silane M, Muecke EC. Experimental obstructive uropathy in fetal rabbits. Invest Urol 1972; 9:335-8. [PMID: 5058771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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