[Therapeutic approach in a fetus with posterior urethral valves].
A pregnant woman was diagnosed with fetal uropathy at 18 weeks gestation. A thorough examination revealed bilateral hydronephrosis, megacystis with bladder neck and posterior urethral dilatation, normohydramnios, normal echocardiography and normal male karyotype. From the 20th week on she developed a progressive oligohydramnios, and the left kidney became hyperechogenic. Fetal urine analysis at week 21 showed hypotonic urine in both renal pelvises, and a beta 2 microglobulin of 8.5 mg/l. on the right side and 18 mg/l. on the left one, suggesting some degree of function on the right kidney. A vesico-amniotic shunt was placed at week 22, which was ineffective, and another shunt was placed two weeks later. Twenty-four hours later the bladder size decreased, but amniotic fluid did not increase and a great amount of ascitis developed, which was attributed to catheter migration. On week 25, the abdomen was decompressed through a peritoneal-amniotic shunt. Ascitis decreased thereafter, but oligohydramnios remained unchanged. The patient died 20 hours after a cesarean section was performed at the 31st week. The necropsy diagnoses were: posterior urethral valves, bilateral renal dysplasia and pulmonary hypoplasia. This case illustrates the difficulty in establishing a prognosis based on the prenatal data available at present.
Albert
A
A
Servicio de Cirugía Pediátrica, Universidad de Barcelona.
Morales
L
L
Puerto
B
B
Borrell
A
A
Sancho
M A
MA
Gonzálezl Linas
L F
LF
D000328:Adult; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000628:therapy; D005260:Female; D005315:Fetal Diseases / Q000601:surgery; D005333:Fetus; D006801:Humans; D006869:Hydronephrosis / Q000601:surgery; D008297:Male; D011247:Pregnancy; D011296:Prenatal Diagnosis; D014521:Urethra / Q000002:abnormalities*
Actitud terapéutica ante un feto con válvulas de uretra posterior.