Fetoscopic urethral meatotomy in fetuses with lower urinary tract obstruction by congenital megalourethra

Abstract

Background To describe the perinatal outcomes of fetoscopic urethral meatotomy (FUM) in fetuses with lower urinary tract obstruction (LUTO) by congenital megalourethra. Study design Between 2012 and 2020, 226 cases with LUTO were referred to our fetal surgery center in Queretaro, Mexico. We report the perinatal outcome of cases with LUTO by congenital megalourethra that were selected for FUM in an attempt to release the penile urethral obstruction. Results Congenital megalourethra was diagnosed in 10 cases (4.4%) but only 3 cases (30%) with obstructive megalourethra and megacystis were selected for fetal surgery. Fetoscopic urethral metatotomy was successfully performed in all three cases at a median gestational age (GA) of 21.4 (18.0–26.7) weeks and with a median surgical time of 27 (12–43) min. A resolution of urethral dilatation and subsequent reduction of the penile length and normalization of both the bladder size and amniotic fluid were observed in all cases. The median GA at delivery was 35.2 (range: 30.6–38.0) weeks. There were no fetal deaths but one neonatal death (33%) secondary to renal failure and preterm delivery. Conclusion In fetuses with LUTO by congenital obstructive megalourethra, FUM is feasible and is associated with good perinatal outcomes.

Anesthesia for fetal operative procedures: A systematic review

“…All studies providing MFA were included in the comparison. The mean LOH resulted to be significantly longer in women who underwent general anesthesia, compared to those who underwent loco-regional anesthesia ( p = 0.0088) ( 16 , 18 , 19 , 32 , 36 , 43 – 45 , 47 , 52 , 55 , 86 , 98 , 100 , 106 , 118 , 153 , 176 ). No other statistically significant differences were found ( Table 2 ).…”

“…MFA was provided in 1,551 procedures from 59 studies ( 12 , 16 – 20 , 30 , 32 , 34 , 36 , 37 , 41 , 43 – 45 , 47 , 49 , 50 , 52 , 54 – 57 , 59 , 62 , 63 , 68 , 83 , 85 , 86 , 88 , 95 , 98 , 100 , 104 , 106 , 108 , 112 , 118 , 119 , 121 , 125 , 127 , 136 , 140 , 141 , 143 – 146 , 150 , 153 , 158 , 163 , 170 , 172 , 176 , 177 ). Fetal anesthesia administration was specified in 50 studies, consisting of 635 intramuscular injections (45 studies), 292 subcutaneous injections (three studies) and four intravenous injections (two studies) ( 16 – 20 , 30 , 32 , 34 , 36 , 37 , 41 , 43 , 44 , 47 , 49 , 50 , 52 , 54 , 55 ,…”

“…Fetal anesthesia administration was specified in 50 studies, consisting of 635 intramuscular injections (45 studies), 292 subcutaneous injections (three studies) and four intravenous injections (two studies) ( 16 – 20 , 30 , 32 , 34 , 36 , 37 , 41 , 43 , 44 , 47 , 49 , 50 , 52 , 54 , 55 , 57 , 59 , 63 , 83 , 86 , 95 , 98 , 100 , 104 , 106 , 108 , 118 , 119 , 121 , 125 , 127 , 136 , 140 , 141 , 143 – 146 , 150 , 153 , 158 , 163 , 170 , 176 , 177 ). An aggregate mean GA at procedure of 27.99 weeks was calculated on 49 studies and 1,404 pregnancies ( 12 , 16 – 19 , 30 , 32 , 34 , 36 , 37 , 41 , 43 – 45 , 47 , 49 , 50 , 52 , 54 – 57 , 59 , 62 , 63 , 68 , …”

“…An aggregate mean GA at procedure of 27.99 weeks was calculated on 49 studies and 1,404 pregnancies ( 12 , 16 – 19 , 30 , 32 , 34 , 36 , 37 , 41 , 43 – 45 , 47 , 49 , 50 , 52 , 54 – 57 , 59 , 62 , 63 , 68 , 83 , 85 , 86 , 88 , 95 , 98 , 100 , 104 , 106 , 108 , 112 , 118 , 119 , 121 , 125 , 127 , 135 , 136 , 140 , 141 , 143 – 146 , 150 , 153 , 158 , 163 , 170 , 172 , 176 , 177 ). Mean LOH, based on data from 18 studies and 92 women, was 3.79 days ( 16 , 18 , 19 , 32 , 36 , 43 – 45 , 47 , 52 , 55 , 86 , 98 , 100 , 106 , 118 , 153 , 176 ...…”

“…Mean LOH, based on data from 18 studies and 92 women, was 3.79 days ( 16 , 18 , 19 , 32 , 36 , 43 – 45 , 47 , 52 , 55 , 86 , 98 , 100 , 106 , 118 , 153 , 176 ). A total of 33 studies (1,196 pregnancies) provided information on the GA at delivery, resulting in an aggregate mean of 34.89 weeks ( 17 – 19 , 37 , 41 , 45 , 49 , 54 , 59 , 108 , 118 , 121 , 125 , 127 , 135 , 136 , 140 , 141 , 143 – 145 , 158 , 170 , 176 , 177 ). PROM occurred in 401 pregnancies (25.85%) and 197 fetal deaths were reported (11.37%).…”