title: Fetoscopic placement of a transurethral stent for intrauterine obstructive uropathy.
abstract: OBJECTIVE
  Fetal urinary obstructive uropathy and consecutive oligohydramnios result in a poor outcome. Usually renal insufficiency and life threatening lung hypoplasia have developed at term. We report a case of in utero fetal cystoscopy and successful placement of a transurethral vesico-amniotic Double-J (Medical Engineering Corp., New York, New York) stent. Indications, results and the potential benefits of different techniques are discussed.
  
  
  METHODS
  A 36-year-old woman (primipara) was evaluated at week 26 due to a male fetus with bilateral hydronephrosis, massive distended bladder and an open posterior urethra. Using local anesthesia the fetal bladder was punctured, a 2.6 mm endoscope was inserted and a wire was advanced antegrade through the penis. A 2.8Fr Double-J stent was then placed between the bladder and amniotic cavity.
  
  
  RESULTS
  The bladder drained into the amnion, hydronephrosis disappeared and the lung developed normally. At week 37 a healthy infant was delivered who voided spontaneously.
  
  
  CONCLUSIONS
  After careful selection of candidates for fetal intervention in obstructive uropathy direct vision fetoscopy and transurethral stent placement can be performed in patients with oligohydramnios, favorable urinary electrolytes and normal appearing kidneys.
authors.affiliation: Department of Urology, Medical School, Philipps-Universität Marburg, Germany. R.Hoffmann@med.uni-marburg.de
authors.forename: Rainer
authors.initials: R
authors.lastname: Hofmann
authors.forename: Tanja
authors.initials: T
authors.lastname: Becker
authors.forename: Matthias
authors.initials: M
authors.lastname: Meyer-Wittkopf
authors.forename: Ismail
authors.initials: I
authors.lastname: Tekesin
authors.forename: Felix
authors.initials: F
authors.lastname: Sierra
authors.forename: Stephan
authors.initials: S
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D005260:Female; D005332:Fetoscopy / Q000379:methods; D006801:Humans; D006869:Hydronephrosis / Q000150:complications / Q000628:therapy*; D011247:Pregnancy; D015607:Stents; D014517:Ureteral Obstruction / Q000209:etiology / Q000628:therapy*; D014521:Urethra