Article

Fetal lower urinary tract obstruction.

General Surgery, The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Clinics in perinatology (Impact Factor: 2.13). 07/2009; 36(2):377-90, x. DOI: 10.1016/j.clp.2009.03.010
Source: PubMed

ABSTRACT The authors present an overview of the prenatal diagnosis, evaluation, contemporary intervention, and antenatal management of lower urinary tract obstruction. They review early experimental models that confirmed the relation between urinary tract obstruction and renal fibrocystic dysplasia and that early in utero relief of the obstruction could prevent irreversible renal injury. Subsequent studies of the electrolyte and protein concentrations in fetal urine from human cases established prognostic threshold values and helped to develop an algorithm to select candidates for antenatal therapy. Although shunting has improved survival, long-term morbidities remain a significant challenge.

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    ABSTRACT: Objective To describe the surgical technical aspects related to urological fistulas after fetal antegrade cystoscopic laser fulguration of the posterior urethral valves (PUV).Methods The perioperative data for all fetal cystoscopies performed between January 2004 and August 2013 at three institutions in the U.S.A., France and Brazil were reviewed with particular emphasis on surgical technical aspects and complications.ResultsA total of 40 fetal cystoscopies were performed at the three institutions, laser fulguration of the PUV was performed in 23 of these cases with a survival rate of 60.9% (14/23) and normal renal function in 85.7% (12/14) infants. Urinary tract fistulas were diagnosed postnatally in four (10%) newborns. The fistulas were associated with higher gestational age at diagnosis (p=0.03), semi-curved rather than curved sheaths (p<0.01), the use of diode laser (p<0.01) and higher laser power and energy (p=0.02 and p=0.01, respectively).Conclusion Urological fistulas are a severe complication of fetal cystoscopic laser fulguration of PUV, which are associated with surgical technique such as type, energy and power settings of the laser and instrumentation. Use of correct instruments and proper training are necessary to safely perform this fetal intervention.
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