In-utero treatment of fetal bladderoutlet obstruction by a ureterocele

Quintero, Rubén A.; Homsy, Yves; Bornick, P. W.; Allen, Mary; Johnson, Patricia K.

doi:10.1016/s0140-6736(00)05084-4

Cited by 53 publications

(27 citation statements)

References 3 publications

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“…However, most fetal ureteroceles are detected during the investigation of unilateral hydronephrosis, in which a more detailed scan often reveals kidney duplication and the hypoechoic image inside the bladder. As in case 1, sometimes the ureterocele can occlude or even protrude through the urethra, and a clinical picture of megacystis, bilateral hydronephrosis and oligohydramnios can develop [8]. Prenatal therapy should be offered in those cases developing before fetal viability, in order to prevent severe renal damage.…”

Section: Discussionmentioning

confidence: 99%

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Ureterocele: Antenatal Diagnosis and Management

Godinho¹,

Nunes²,

Janeiro

et al. 2013

Fetal Diagn Ther

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Ureteroceles are cystic dilations of the intravesical submucosal ureter. Most cases are associated with complete ureteral and renal duplication, and association with ureterohydronephrosis is frequent. The authors describe the 4 cases of fetal ureterocele diagnosed from March 2008 to March 2012. Mean gestational age at diagnosis was 23 weeks (16-34 weeks). One of 4 cases progressed to severe hydronephrosis with megacystis and was referred to a Fetal Medicine Center for fetoscopy and laser ureterocelotomy. The remaining 3 cases did not need fetal therapy. Mean gestational age at delivery was 37 weeks. One case abandoned follow-up; 2 children were submitted to cystoscopic ureterocele incision and the child submitted to fetal therapy needed heminephrectomy due to recurrent urinary tract infections. In those 3 cases renal function was preserved. When a fetal ureterocele is diagnosed, close sonographic surveillance should be offered to monitor the possible urinary tract obstruction and assess the need for prenatal intervention. Fetal diagnosis is important to program the timing of delivery and postnatal care.

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Section: Discussionmentioning

confidence: 99%

“…Prenatal therapy should be offered in those cases developing before fetal viability, in order to prevent severe renal damage. Options include sonographically guided percutaneous drainage [9] or laser treatment [10], or more definite therapy by fetoscopy and in utero incision of the ureterocele [8]. …”

Section: Discussionmentioning

confidence: 99%

Ureterocele: Antenatal Diagnosis and Management

Godinho¹,

Nunes²,

Janeiro

et al. 2013

Fetal Diagn Ther

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“…Replacement of the shunt is associated with an additive risk of fetal death, chorioamnionitis, premature rupture of membranes, and miscarriage or preterm delivery, for a total perinatal loss of approximately 5 percent per instance. 31 …”

Section: Complications Of Vesicoamniotic Shuntingmentioning

confidence: 99%

Lower Urinary Tract Obstruction

Hajdú¹,

Harmath²,

Pete³

et al. 2007

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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Lower urinary tract obstruction is defined as partial or complete obstruction of the urinary tract at the level of the urethra and the bladder. The posterior urethral valves are the most common cause, 9 percent of the fetal uropathies. The incidence range is wide, because of different databases show different populations. The most severe obstructive uropathy is in patients with kidney damage, oligohydramnios and pulmonary insufficiency. If no prenatal intervention is performed, 45 percent of these patients die in the first 3 weeks of life and 25 percent have renal failure. In utero therapy is indicated to prevent renal damage and pulmonary hypoplasia in cases associated with progressive development of oligohydramnios. The treatment is usually limited to male fetuses with bladder outlet obstruction. The selection criteria (contraindications of fetal intervention) are: normal amniotic fluid volume, suggestion of nonobstructive dilatation of the urinary tract, sonographic evidence of renal cystic dysplasia, abnormal fetal urinary parameters, abnormal karyotype, presence of associated major congenital anomalies, fetal urinary parameters are above threshold. At the follow up after a prenatal intervention showed an apparent statistically significant improvement in perinatal survival with prenatal intervention relative to no intervention. Furthermore, there was no significant difference between the proportions of survivors with normal renal function who underwent bladder drainage and those who did not. Improved perinatal survival was also suggested in those fetuses with a poor prognosis. A nonsignificant improvement in perinatal survival for those fetuses with a good prognosis was also seen.

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“…A vesicoamniotic shunt was placed with successful decompression. Quintero et al [20] recently reported using fetal cystoscopy for first-line management of a fetal ureterocele near 22 weeks' gestation complicated by a large bladder and oligohydramnios. The procedure successfully restored amniotic fluid and allowed the pregnancy to continue until term.…”

Section: Ureterocele Puncturementioning

confidence: 99%

Antenatal hydronephrosis: Evaluation and outcome

et al. 2002

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We present a comprehensive and current review of the etiology, evaluation, treatment, and outcome of antenatal hydronephrosis. When a diagnosis of antenatal hydronephrosis is made, many questions regarding pregnancy, prenatal care, intervention, and what may be expected after birth are raised. Debate and controversy exist on the diagnosis and subsequent evaluation and management of the child with antenatal hydronephrosis. A review of the literature and our own experience with antenatal hydronephrosis are presented in order to guide the physician who is caring for mother and child.

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In-utero treatment of fetal bladderoutlet obstruction by a ureterocele

Cited by 53 publications

References 3 publications

Ureterocele: Antenatal Diagnosis and Management

Ureterocele: Antenatal Diagnosis and Management

Lower Urinary Tract Obstruction

Antenatal hydronephrosis: Evaluation and outcome

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