title: Fetal cystoscopy in the management of fetal obstructive uropathy: experience in a single European centre.
abstract: 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.
authors.affiliation: Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, and Institute of Reproductive and Developmental Biology Imperial College London, (Hammersmith Campus), UK.
authors.forename: Alec
authors.initials: A
authors.lastname: Welsh
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Agarwal
authors.forename: Sailesh
authors.initials: S
authors.lastname: Kumar
authors.forename: Richard P
authors.initials: RP
authors.lastname: Smith
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Fisk
mesh_terms: 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*