Double Shunt in a Case of Fetal Low-Level Obstructive Uropathy

Noia, G.; Santis, Marco De; Mastromarino, Carmen; Trivellini, Carmen; Romano, Domenico; Caruso, Alessandro; Mancuso, Salvatore

doi:10.1159/000264331

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…In those fetuses not terminated, there is the vexed question as to what if any fetal intervention should be offered. Options extend from no intervention, through the placement of vesicoamniotic shunts [20][21][22], to open vesicostomy [23,24], or the fetal ablation of the valves currently being pioneered by Quintero et al [25]. Our experiences in patients with PUV who have good pulmonary function but who have Kitagawa/Pringle/Stone/Flower/Murakami/ Robinson developed renal failure in infancy would encourage us to offer vesico-amniotic shunting at diagnosis, in those fetuses for whom the parents elect to continue the pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Postnatal Follow-Up of Hydronephrosis Detected by Prenatal Ultrasound: The Natural History

Kitagawa¹,

Pringle²,

Stone³

et al. 1998

Fetal Diagn Ther

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Babies with hydronephrosis detected antenatally who were born at or referred to our hospital from 1990 to 1995 were followed up with ultrasound (U/S), micturating cystourethrogram (MCU) or nuclear medicine studies after birth. One hundred and three patients were diagnosed antenatally at 17–42 weeks gestation. Twelve cases were excluded from the analysis of the results because of incomplete data. Fifty-one (56%) patients had hydronephrosis without organic obstruction, and 80% of these became normal in 3 years. Fifteen patients (17%) had a normal scan 4 days after birth. This suggests the possibility of antenatal spontaneous regression. Seven (8%) had a ureterocele and 4 (5%) had pelviureteric junction (PUJ) obstruction. Four (5%) had vesicoureteric reflux, and 4 (5%) had primary megaureter. Two (2%) had posterior urethral valves (PUV), 3 (3%) had refluxing primary megaureter, and 1 (1%) had urethral atresia. Fifteen patients (17%) underwent surgical intervention. Six had a nephrectomy, 1 a vesicostomy, 3 an Anderson-Hynes pyeloplasty, 3 had the ureterocele unroofed, 1 had a ureteric reimplant, and 1 ablation of valves. In 42 infants with 60 abnormal kidneys, the renal anteroposterior diameter of the pelvis was measured. Retrospectively, 48 kidneys diagnosed as having hydronephrosis, antenatally had a renal pelvis diameter ≥4 mm before 33 weeks gestation or ≥7 mm after 33 weeks gestation. One patient with PUJ obstruction lost kidney function, but there is no good marker to detect these patients. Early unroofing of ureteroceles may rescue kidney function. Our follow-up protocol for antenatal hydronephrosis is U/S at 4 days, 1 month and 1 year of age. An MCU is not required unless the ureter is seen on antenatal U/S. If dilatation persists past 1 month, a radionucleotide (MAG3) scan and repeat U/S are performed at 3 months. The methods for assessing obstruction and the indications for surgical intervention in these patients require reexamination.

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Section: Discussionmentioning

confidence: 99%

Postnatal Follow-Up of Hydronephrosis Detected by Prenatal Ultrasound: The Natural History

Kitagawa¹,

Pringle²,

Stone³

et al. 1998

Fetal Diagn Ther

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“…It is based in Rome and is a result of a ªteam approachº of specialists in pediatric surgery, OB/GYN, pathology, veterinary medicine, ethics and nursing. We used different experimental models (18,20) and human ultrasound-guided fetal therapy for urinary tract malformations, pleural effusions and fetal goiter (15,16). As a result of the analysis of the above-mentioned data, we came to the following opinion on fetal surgery for SBA in humans.…”

Section: Discussionmentioning

confidence: 99%

Fetal Surgery for Spina Bifida Aperta: To Be or Not to Be?

et al. 2002

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Fetal SBA (spina bifida aperta) has been operated upon in more than 213 cases in the USA in the last 8 years. Indications and results still remain controversial. Our group reproduced successfully Meuli's model in sheep and reviewed the literature on SBA and the Internet updated sites on the theme. Then we reviewed the follow-up of all cases operated upon postnatally in 20 years at a Neurosurgery Department in Rome. We published all the data regarding the three above-mentioned steps. This paper contains reflections on the three, and our opinion on the correct approach to prenatally diagnosed SBA, as far as fetal surgery is concerned.

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“…Although not a fail‐safe method because of a high incidence of obstructions of the shunt, displacements, and fetal damages, possibilities of success at that age of gestation are very high. 2,3…”

Section: Clinical Case Of a Living Newborn After Placement Of Amniotimentioning

confidence: 99%