Fetal cystoscopy for severe lower urinary tract obstruction--initial experience of a single center.
OBJECTIVE
To report the experience with fetal cystoscopy and laser fulguration of posterior urethral values (PUV) for severe lower urinary tract obstruction (LUTO).


METHODS
Between July 2006 and December 2008, fetal cystoscopy was offered to 23 patients whose fetuses presented with severe LUTO, favorable urinary analysis and gestational age <26 weeks. Fetal urinary biochemistry was evaluated before and after cystoscopy. All infants were followed 6-12 months after birth. Abnormal renal function was defined when serum creatinine higher than 50 micromol/L (2 Standard Deviation) or the necessity of dialysis or renal transplantation. Autopsy was always performed whenever fetal or neonatal deaths occurred.


RESULTS
Eleven patients decided to undergo fetal therapy and 12 elected to continue with expectant observation. There was no difference between both groups in gestation age at diagnosis and referral examinations. Urethral atresia was diagnosed in 4/11 (36.4%) fetuses by fetal cystoscopy. At 26 weeks, fetuses that were managed expectantly presented with worse urinary biochemistry results (p < 0.05). Survival rates and percentage of infants with normal renal function were significantly higher in the cystoscopic group than in the expectant group (p < 0.05).


CONCLUSIONS
Percutaneous fetal cystoscopy is feasible using a thinner special cannula for prenatal diagnosis and therapy of LUTO. Prenatal laser ablation of the PUV under cystoscopy may prevent renal function deterioration improving postnatal outcome.
Ruano
Rodrigo
R
Obstetrics Department, Faculty of Medicine, São Paulo University, Rua Valentim Magalhães 100, São Paulo, SP, Brazil. rodrigoruano@hotmail.com
Duarte
Sergio
S
Bunduki
Victor
V
Giron
Amilcar Martins
AM
Srougi
Miguel
M
Zugaib
Marcelo
M
D000328:Adult; D003558:Cystoscopy / Q000379:methods*; D004106:Dilatation / Q000295:instrumentation / Q000379:methods; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000601:surgery; D005865:Gestational Age; D006801:Humans; D053685:Laser Therapy / Q000379:methods; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome; D014521:Urethra / Q000002:abnormalities* / Q000601:surgery; D014524:Urethral Obstruction / Q000175:diagnosis* / Q000196:embryology / Q000601:surgery