title: Fetal megacystis: etiologies, management, and outcome according to the trimester.
abstract: OBJECTIVE
  To describe the diagnostic criteria and outcome of fetal megacystis according to the gestational age at diagnosis.
  
  
  METHODS
  A 7-year retrospective study was carried out from 2004 to 2011, including cases of megacystis referred to 2 prenatal fetal medicine units. The following data were collected and analyzed: maternal age, term at diagnosis (gestational weeks), ultrasonographic and magnetic resonance imaging data, karyotype, decision of the multidisciplinary prenatal team, fetopathology in cases of termination of pregnancy or fetal death, final diagnosis at birth after ultrasonography and voiding cystourethrography, and medical and surgical follow-up.
  
  
  RESULTS
  Of the 69 fetuses included in this study, 82.6% were males; 26 were diagnosed during the first trimester, 21 during the second, and 22 during the third. During the first trimester, the main etiologies were urethral occlusions and prune-belly syndrome with poor fetal prognosis. Nineteen pregnancies (69%) were terminated for medical reasons including the association with other malformations, poor evolution, or miscarriage. Only 4 children were born alive. The main etiologies of megacystis discovered during the second and third trimesters were vesicoureteral reflux and urethral occlusion. Twenty of 22 fetuses (91%) were born alive when the fetal megacystis was discovered after 27 weeks of gestation.
  
  
  CONCLUSIONS
  Antenatal discovery of megacystis is a complex and challenging prognostic situation. The prognosis depends on the gestational age at discovery. Megacystis is not always associated with obstruction. In a newborn with megacystis, bladder outlet obstruction has to be excluded. Optimal counseling of the involved parents requires a multidisciplinary approach.
authors.affiliation: Department of Pediatric Surgery, Timone and North Children's Hospital, Aix-Marseille University and Assistance Publique-Hôpitaux de Marseille, Marseille, France. Electronic address: Lucile.fievet@ap-hm.fr.
authors.forename: Lucile
authors.initials: L
authors.lastname: Fievet
authors.affiliation: Department of Pediatric Surgery, Timone and North Children's Hospital, Aix-Marseille University and Assistance Publique-Hôpitaux de Marseille, Marseille, France.
authors.forename: Alice
authors.initials: A
authors.lastname: Faure
authors.affiliation: Department of Pediatric and Prenatal Imaging, Timone and North Hospital, Aix-Marseille University and Assistance Publique-Hôpitaux de Marseille, Marseille, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Coze
authors.affiliation: Department of Pediatric Surgery, CHU Felix Guyon, Bellepierre, Saint-Denis de La Reunion, France.
authors.forename: Luke
authors.initials: L
authors.lastname: Harper
authors.affiliation: Department of Pediatric Surgery, Timone and North Children's Hospital, Aix-Marseille University and Assistance Publique-Hôpitaux de Marseille, Marseille, France.
authors.forename: Nicoleta
authors.initials: N
authors.lastname: Panait
authors.affiliation: Department of Statistical, Timone Children's Hospital, Aix-Marseille University and Assistance Publique-Hôpitaux de Marseille, Marseille, France.
authors.forename: David
authors.initials: D
authors.lastname: Braunstein
authors.affiliation: Department of Pediatric Surgery, Timone and North Children's Hospital, Aix-Marseille University and Assistance Publique-Hôpitaux de Marseille, Marseille, France.
authors.forename: James
authors.initials: J
authors.lastname: Carson
authors.affiliation: Department of Pediatric and Prenatal Imaging, Timone and North Hospital, Aix-Marseille University and Assistance Publique-Hôpitaux de Marseille, Marseille, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Gorincour
authors.affiliation: Department of Pediatric and Prenatal Imaging, Timone and North Hospital, Aix-Marseille University and Assistance Publique-Hôpitaux de Marseille, Marseille, France.
authors.forename: Kathia
authors.initials: K
authors.lastname: Chaumoitre
authors.affiliation: Department of Pediatric Surgery, Timone and North Children's Hospital, Aix-Marseille University and Assistance Publique-Hôpitaux de Marseille, Marseille, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Guys
authors.affiliation: Department of Pediatric Surgery, Timone and North Children's Hospital, Aix-Marseille University and Assistance Publique-Hôpitaux de Marseille, Marseille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Alessandrini
authors.affiliation: Department of Pediatric and Obstetrical Surgery, North Hospital, Aix-Marseille University and Assistance Publique-Hôpitaux de Marseille, Marseille, France.
authors.forename: Claude
authors.initials: C
authors.lastname: D'Ercole
authors.affiliation: Department of Pediatric Surgery, Timone and North Children's Hospital, Aix-Marseille University and Assistance Publique-Hôpitaux de Marseille, Marseille, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Merrot
mesh_terms: D004386:Duodenum / Q000002:abnormalities*; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000209:etiology*; D005865:Gestational Age; D006801:Humans; D008297:Male; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000002:abnormalities*