Early fetal cystoscopy for first‐trimester severe megacystis

Objectives To report the feasibility of early fetal cystoscopy for the prenatal diagnosis and therapy of severe first‐trimester megacystis. Methods Between January 2008 and February 2010, early fetal cystoscopy at 16 weeks of gestation was offered to 15 patients whose fetuses presented with severe f...

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Bibliographic Details
Published in:Ultrasound in obstetrics & gynecology 2011-06, Vol.37 (6), p.696-701
Main Authors: Ruano, R., Yoshisaki, C. T., Salustiano, E. M. A., Giron, A. M., Srougi, M., Zugaib, M.
Format: Article
Language:English
Subjects:
Autopsy
Biological and medical sciences
Birth
cystoscopy
Cystoscopy - methods
Duodenum - abnormalities
Duodenum - diagnostic imaging
Duodenum - embryology
Duodenum - surgery
Endoscopy
Feasibility Studies
Female
Fetal Diseases - diagnostic imaging
Fetal Diseases - surgery
fetal lower urinary tract obstruction
fetal surgery
Fetuses
Gestation
Gynecology
Gynecology. Andrology. Obstetrics
Humans
Infant
Infant, Newborn
Infants
Intestine
Investigative techniques, diagnostic techniques (general aspects)
Kidney
laser therapy
Laser Therapy - methods
Lasers
Male
Medical sciences
megacystis
Neonates
Nephrology. Urinary tract diseases
Obstetrics
posterior urethral valves
Pregnancy
Pregnancy Outcome
Pregnancy Trimester, First
Prenatal Diagnosis
Prospective Studies
Renal function
Survival
Ultrasonography, Prenatal - methods
Ultrasound
Urethra - abnormalities
Urethra - diagnostic imaging
Urethra - surgery
urethral atresia
Urinary bladder
Urinary Bladder - abnormalities
Urinary Bladder - diagnostic imaging
Urinary Bladder - embryology
Urinary Bladder - surgery
Urinary system involvement in other diseases. Miscellaneous
Urinary tract
Urinary tract. Prostate gland
vesicoamniotic shunt
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Description
Summary:Objectives To report the feasibility of early fetal cystoscopy for the prenatal diagnosis and therapy of severe first‐trimester megacystis. Methods Between January 2008 and February 2010, early fetal cystoscopy at 16 weeks of gestation was offered to 15 patients whose fetuses presented with severe first‐trimester megacystis. All infants were followed up for 6–12 months after birth. Autopsy was always performed whenever fetal or neonatal deaths occurred. Results Seven patients decided to undergo fetal therapy, and eight elected to continue with expectant observation. One fetus died before early fetal cystoscopy was performed. Therefore, six fetuses underwent early fetal cystoscopy. Urethral atresia was diagnosed in three fetuses during fetal cystoscopy and confirmed at autopsy following termination of pregnancy at 19–20 weeks in all cases. Posterior urethral valves were diagnosed and successfully fulgurated by laser during early cystoscopy in three fetuses, two of which survived with normal renal and bladder function after birth; the remaining fetus had a postnatal diagnosis of megacystis‐microcolon intestinal hypoperistalsis syndrome and died neonatally. In the expectantly managed group, no survivals were observed, even among cases with ‘isolated’ posterior urethral valves. Conclusions Percutaneous early fetal cystoscopy is feasible for prenatal diagnosis and therapy of severe megacystis. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.
ISSN:0960-7692
1469-0705
1469-0705
DOI:10.1002/uog.8963