Sonography of fetal micturition

Vijayaraghavan, S. Boopathy

doi:10.1002/uog.1755

Cited by 17 publications

(13 citation statements)

References 14 publications

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“…9 The estimated incidence of this malformation ranges from 0.2 to 4.1 per 1,000 live births of both sexes, 10,11 and associated urogenital abnormalities in children may be as high as 40%, with extra-urogenital malformations in 7-10%. 12,13 Sonographic findings that may suggest this anomaly include: an abnormal distal morphology of the penis, which loses its pointed extremity; 2 echogenic longitudinal lines corresponding to small lateral folds that belong to the dermal remains of the prepuce; ventral curvature of the penis (chordee); a ventral urinary stream 5,14 ; and the ''tulip sign,'' 2 which represents the severe curvature of the penis in association with penoscrotal transposition of a bifid scrotum. In our case, there was a penoscrotal hypospadias but the scrotum was not bifid, yet the sonographic appearance of the gentalia was similar to the tulip sign reported by Meizner et al 2 Fetal sex determination can be performed as early as 11 weeks' gestation with an accuracy of 70.3%, increasing to close to 100% at 13-14 weeks.…”

Section: Discussionmentioning

confidence: 99%

Hypospadias mimicking female genitalia on early second trimester sonographic examination

Odeh

Ophir

Bornstein

2008

J of Clinical Ultrasound

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Female fetal sex was assigned based on downward direction of the genital tubercle at 14 weeks' gestation. Subsequently, amniocentesis performed due to the finding of an echogenic focus in the left ventricle revealed a male karyotype. Sonographic examination at 22 weeks' gestation revealed a markedly curved penile shaft. Power Doppler at that time demonstrated a urine jet emanating from the penile base, verifying the diagnosis of penoscrotal hypospadias. We therefore suggest that female fetal sex assignment should be based on the demonstration of the 2 or 4 parallel lines representing the labial folds and not only upon the demonstration of the downward direction of the genital tubercle.

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Section: Discussionmentioning

confidence: 99%

Hypospadias mimicking female genitalia on early second trimester sonographic examination

Odeh

Ophir

Bornstein

2008

J of Clinical Ultrasound

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“…The approach can be anterocaudal or posterocaudal, depending on the fetal position. The application of this technique to study fetal micturition has been described previously1. In the female fetus the urinary bladder with urethra is seen anteriorly, the vagina in the middle and the rectum and anal canal are seen posteriorly (Figure 1).…”

Section: Case Reportsmentioning

confidence: 99%

“…The urinary bladder appeared normal. Because of the bilateral hydroureteronephrosis, fetal micturition was examined by perineal ultrasonography as described1 and was found to be normal. The urinary bladder emptied completely.…”

Section: Case Reportsmentioning

confidence: 99%

Fetal perineal sonography in the diagnosis of ectopic ureteric opening

Vijayaraghavan¹

2007

Ultrasound in Obstet & Gyne

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CASE REPORTSSagittal ultrasound imaging of the fetal perineum, pelvis and external genitalia can be performed using a highfrequency probe. The approach can be anterocaudal or posterocaudal, depending on the fetal position. The application of this technique to study fetal micturition has been described previously 1 . In the female fetus the urinary bladder with urethra is seen anteriorly, the vagina in the middle and the rectum and anal canal are seen posteriorly (Figure 1). In the male fetus the urinary bladder and the urethra are seen anteriorly and the rectum and anal canal are seen posteriorly ( Figure 2). Case 1A 27-year-old primigravida was referred with suspected fetal bilateral hydronephrosis. The female fetus had biometry consistent with a gestational age of 31 weeks. The amniotic fluid volume was normal. The fetus showed bilateral gross hydroureteronephrosis. Both the ureters were dilated and tortuous, showing hyperperistalsis. The urinary bladder appeared normal. Because of the bilateral hydroureteronephrosis, fetal micturition was examined by perineal ultrasonography as described 1 and was found to be normal. The urinary bladder emptied completely.Perineal sonography also revealed extension of the distal ends of the dilated ureters, low into the pelvis beyond the urinary bladder ( Figure 3). As peristalsis of the distal ureter was observed, it was seen to progress down and continue as a distension of the urethra (Videoclip S1). These features were suggestive of bilateral single-system ectopic ureters opening into the urethra. Spontaneous delivery occurred at term and the neonate was found to have a covered anus, which was later corrected. Follow-up ultrasound examination was carried out on the 27 th postnatal day and showed bilateral moderate hydroureteronephrosis. Both the ureters were grossly dilated. The urinary bladder was empty and did not fill up during the 30 min of scanning. On perineal sonography, both the ureters were seen to open ectopically into the urethra. The micturating cystourethrogram (MCU) showed a small capacity urinary bladder. During the MCU the catheter entered into the left ureter from the urethra, confirming ectopic ureteric opening into the urethra. At surgery the capacity of the urinary bladder was 30 mL. The trigone was absent, with ectopic opening of the ureters. Bilateral ureteric reimplantation was carried out. The child was doing well postoperatively. Case 2An 18-year-old primigravida with first-degree consanguinity was referred for an evaluation of fetal bilateral hydronephrosis. The male fetus had biometry consistent with a gestational age of 24 weeks. The amniotic fluid volume was normal. There was a duplex collecting system of both fetal kidneys with gross hydroureteronephrosis of the upper moiety on both sides. The collecting system of the lower moiety was not dilated on both sides.

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“…Visualization of fetal micturition is also possible by means of Doppler ultrasound. Boopathy Vijayaraghavan detected fetal micturition, posterior urethra ballooning, and urinary streams from the external urethral meatus by sonography, which is potentially valuable in the diagnosis of posterior urethral valves and hypospadias.…”

Section: Bladder Function Development In Fetusesmentioning

confidence: 99%