Bladder Distention and Pyelectasis in the Male Fetus: Causes, Comparisons, and Contrasts

Montemarano, H.; Bulas, Dorothy; Rushton, H. Gil; Selby, Dena M.

doi:10.1097/00005392-199907000-00097

Cited by 11 publications

(25 citation statements)

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“…Au second et au troisième trimestre, la définition n'est pas clairement établie et le diagnostic repose sur des critères subjectifs : « large vessie foetale » qui ne se vide pas au bout de 45 minutes d'examen [4].…”

Section: Discussionunclassified

Diagnostic anténatal de mégavessie au premier trimestre de la grossesse. Étude rétrospective sur six années

Boissier

Varlet

Chauleur

et al. 2009

Gynécologie Obstétrique & Fertilité

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Section: Discussionunclassified

Diagnostic anténatal de mégavessie au premier trimestre de la grossesse. Étude rétrospective sur six années

Boissier

Varlet

Chauleur

et al. 2009

Gynécologie Obstétrique & Fertilité

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“…In the others, bladders enlarged further and/or abnormal, echogenic kidneys developed; 32 no case with a bladder diameter >15 mm spontaneously resolved. 57 Similarly, while bladders are usually thick-walled in newly-diagnosed cases of PUV, 53,58 such appearances can occur in PBS. Rarely, such a degree of megacystis can resolve antenatally without intervention and represents spontaneous rupture of PUV.…”

Section: Presenting Clinical Features Before Birthmentioning

confidence: 99%

“…32 These cases therefore likely represent true BOO. 57 In fact, when definitive histological or postnatal diagnostic data are available, it is apparent that PUV tends to be overdiagnosed compared to perhaps less familiar urethral lesions. 55 When congenital BOO is diagnosed at 12-17 weeks gestation, histological analyses at postmortem show that urethral atresia is commoner than PUV.…”

Section: Presenting Clinical Features Before Birthmentioning

confidence: 99%

“…56 Later in gestation, although the 'keyhole' sign (dilatation of the urethra directly adjacent to the bladder) is considered suggestive of PUV, 53 such an appearance does not occur in every case and, moreover, the same appearance can be found with other primary urethral lesions such as PBS. 57,62 On the other hand, some studies have found that the presence of increased echogenicity in both kidneys, representing renal hypoplasia and/or dysplasia, together with oligohydramnios, itself explained by urethral obstruction and/or decreased urine production by damaged kidneys, favours the diagnosis of BOO. 57 In fact, when definitive histological or postnatal diagnostic data are available, it is apparent that PUV tends to be overdiagnosed compared to perhaps less familiar urethral lesions.…”

Section: Presenting Clinical Features Before Birthmentioning

confidence: 99%

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Congenital Urinary Bladder Outlet Obstruction

Farrugia¹,

Woolf²

2010

Fet. Matern. Med. Rev.

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INTRODUCTIONThe term congenital 'bladder outlet obstruction (BOO)' describes the collection of conditions in which the normal, urethral egress of urine from the fetal bladder is impaired. The term is interchangeable with fetal 'lower urinary tract obstruction', as used by other authors. 1,2 After considering normal urinary tract embryology, we describe the epidemiology of congenital BOO and the primary anatomical disorders associated with it. We then proceed to describe its fetal and postnatal clinical manifestations and then consider therapies and interventions which have been used to manage the condition. We not only focus on urethral and bladder disease with constitutes BOO itself, but also describe associated kidney disorders which, via chronic renal excretory failure, are important causes of morbidity. Rather than provide an exhaustive review, we emphasise studies published in the last decade, and therefore readers are referred to other reviews 3-7 citing numerous earlier references. EMBRYOLOGYCongenital BOO is but one entity in a spectrum of renal tract anomalies which include kidney malformations (e.g. absent, small and abnormally-differentiated kidneys) and ureter malformations (e.g. duplicated, refluxing and obstructed uterers). 8 In fact, the lower and upper renal tract develop harmoniously, 9,10 so that the former is ready to receive urine first produced by metanephric kidneys between 8-10 weeks of human gestation, when the first layers of vascularised, and thus filtering, glomeruli are forming. In the seventh week after fertilisation, the cloaca divides into the urogenital sinus and the rectum. By the end of the first trimester the upper part of the sinus has differentiated into a muscularised urinary bladder, with the lower part forming the opening, or 'proximal ', urethra. 11 Ureteric smooth muscle is also forming at this time 12-13 and its peristalsis propels urine from the renal pelvis towards the bladder. 14

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“…8 In the second trimester, megacystis has been defined as "an abnormally enlarged bladder that does not empty over a 45 min period". 9 The sensitivity and specificity for the diagnosis of LUTO increases with the identification of additional abnormalities of the renal tract, including renal cystic parenchymal disease. 10 Assessment at diagnosis includes a detailed ultrasonographic examination (in some cases after amnio-infusion of warmed physiological saline) to exclude the presence of co-existing anomalies.…”

Section: Prenatal Managementmentioning

confidence: 99%

Fetal therapy for the treatment of congenital bladder neck obstruction

Kilby

Morris

2014

Nat Rev Urol

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Lower urinary tract obstruction (LUTO) comprises a heterogeneous group of pathologies associated with early-onset oligohydramnios and cystic renal disease that have high rates of perinatal morbidity (from renal disease) and mortality (from pulmonary hypoplasia). The use of prenatal detailed ultrasonography and fetal urine analysis has been only partially successful in identifying fetuses with LUTO with relatively good prognosis that would benefit from in utero therapy. The most common prenatal therapy is vesicoamniotic shunting. Newer techniques, such as fetal cystoscopy, have potential for enhancing prenatal triage and simultaneously delivering treatment. Vesicoamniotic shunting seems to improve perinatal survival, but whether this treatment or conservative management is used, the surviving children have a high rate of end-stage renal failure requiring dialysis and transplantation. Further investigation of long-term outcomes of vesicoamniotic shunting and fetal cystoscopy is hoped to delineate the risks and benefits of these prenatal treatments and inform management strategies.

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Bladder Distention and Pyelectasis in the Male Fetus: Causes, Comparisons, and Contrasts

Cited by 11 publications

References 0 publications

Diagnostic anténatal de mégavessie au premier trimestre de la grossesse. Étude rétrospective sur six années

Diagnostic anténatal de mégavessie au premier trimestre de la grossesse. Étude rétrospective sur six années

Congenital Urinary Bladder Outlet Obstruction

Fetal therapy for the treatment of congenital bladder neck obstruction

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