Fetal cystoscopy in the management of fetal obstructive uropathy: experience in a single European centre.
OBJECTIVE
To audit diagnostic and therapeutic fetal cystoscopy for suspected posterior urethral valves (PUV).


METHODS
In 13 fetuses, (14-28 weeks) the bladder was entered with a 1.3 mm embryo-fetoscope and intravesical findings documented. In 10 fetuses, an attempt was made to treat the obstruction by saline hydro-ablation (n = 4) and/or guide-wire passage (n = 9). Renal function was assessed post-natally at 10 to 34 months.


RESULTS
The bladder wall was visualised in 12/13 cases and the bladder neck in 11; in 10 cases the upper urethra was entered, and the obstruction visualised in five. PUV were 'seen' in 4/9 confirmed cases, but also in one case of urethral atresia, while in two others the degree of resistance to guide-wire passage suggested atresia or prune belly. Therapeutic attempts were technically successful, at least initially, in 6/10 cases. Of the five cases with confirmed PUV and normal fetal urinary electrolytes, two have acceptable renal function at follow-up. Hydro-ablation in one case resulted in resolution of sonographic signs of obstruction, and ablated valves were confirmed post-natally.


CONCLUSIONS
Semi-rigid fetal cystoscopy allows entry into the upper urethra in most obstructive uropathies, although bladder neck angulation precludes visualisation of the site of obstruction in the majority. Guide-wire passage or hydro-ablation may allow relatively atraumatic ablation of PUV in utero without the chronic bladder decompression associated with vesico-amniotic shunting. However, current technical limitations need to be overcome, possibly by the use of flexible or angled fetoscopes, before the role of cystoscopic treatment can be formally evaluated.
Welsh
Alec
A
Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, and Institute of Reproductive and Developmental Biology Imperial College London, (Hammersmith Campus), UK.
Agarwal
Sanjiv
S
Kumar
Sailesh
S
Smith
Richard P
RP
Fisk
Nicholas M
NM
D003558:Cystoscopy / Q000379:methods*; D004108:Dilatation, Pathologic; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D007677:Kidney Function Tests; D008131:London / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D011183:Postoperative Complications; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal; D014524:Urethral Obstruction / Q000151:congenital / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*