title: Early fetal cystoscopy for first-trimester severe megacystis.
abstract: OBJECTIVE
  To report the feasibility of early fetal cystoscopy for the prenatal diagnosis and therapy of severe first-trimester megacystis.
  
  
  METHODS
  Between January 2008 and February 2010, early fetal cystoscopy at 16 weeks of gestation was offered to 15 patients whose fetuses presented with severe first-trimester megacystis. All infants were followed up for 6-12 months after birth. Autopsy was always performed whenever fetal or neonatal deaths occurred.
  
  
  RESULTS
  Seven patients decided to undergo fetal therapy, and eight elected to continue with expectant observation. One fetus died before early fetal cystoscopy was performed. Therefore, six fetuses underwent early fetal cystoscopy. Urethral atresia was diagnosed in three fetuses during fetal cystoscopy and confirmed at autopsy following termination of pregnancy at 19-20 weeks in all cases. Posterior urethral valves were diagnosed and successfully fulgurated by laser during early cystoscopy in three fetuses, two of which survived with normal renal and bladder function after birth; the remaining fetus had a postnatal diagnosis of megacystis-microcolon intestinal hypoperistalsis syndrome and died neonatally. In the expectantly managed group, no survivals were observed, even among cases with 'isolated' posterior urethral valves.
  
  
  CONCLUSIONS
  Percutaneous early fetal cystoscopy is feasible for prenatal diagnosis and therapy of severe megacystis.
authors.affiliation: Obstetrics Department, Faculty of Medicine, São Paulo University, São Paulo, Brazil. rodrigoruano@hotmail.com
authors.forename: R
authors.initials: R
authors.lastname: Ruano
authors.forename: C T
authors.initials: CT
authors.lastname: Yoshisaki
authors.forename: E M A
authors.initials: EM
authors.lastname: Salustiano
authors.forename: A M
authors.initials: AM
authors.lastname: Giron
authors.forename: M
authors.initials: M
authors.lastname: Srougi
authors.forename: M
authors.initials: M
authors.lastname: Zugaib
mesh_terms: D003558:Cystoscopy / Q000379:methods*; D004386:Duodenum / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000196:embryology / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053685:Laser Therapy / Q000379:methods; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First; D011296:Prenatal Diagnosis; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014521:Urethra / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery; D001743:Urinary Bladder / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000196:embryology / Q000601:surgery*