title: Laser ablation of posterior urethral valves by fetal cystoscopy.
abstract: OBJECTIVE
  To report the results of fetal cystoscopic laser ablation of posterior urethral valves (PUV) in a consecutive series in two referral centers.
  
  
  METHODS
  Twenty pregnant women with a presumptive isolated PUV were treated with fetal cystoscopy under local anesthesia. Identification and fulguration of the PUV by one or several firing-contacts with diode laser were attempted. Perinatal and long-term outcomes were prospectively recorded.
  
  
  RESULTS
  The median gestational age at procedure was 18.1 weeks (range 15.0-25.6), and median operation time was 24 min (range 15-40). Access to the urethra was achieved in 19/20 (95%) cases, and postoperative, normalization of bladder size and amniotic fluid was observed in 16/20 (80%). Overall, there were 9 (45%) terminations of pregnancy and 11 women (55%) delivered a liveborn baby at a mean gestational age of 37.3 (29.1-40.2) weeks. No infants developed pulmonary hypoplasia and all were alive at 15-110 months. Eight (40% of all fetuses, 72.7% of newborns) had normal renal function and 3 (27.3%) had renal failure awaiting renal transplantation.
  
  
  CONCLUSIONS
  Fetoscopic laser ablation for PUV can achieve bladder decompression and amniotic fluid normalization with a single procedure in selected cases with anyhydramnios. There is still a significant risk of progression to renal failure pre or postnatally.
authors.affiliation: BC Natal, Barcelona Center for Maternal-Fetal Medicine and Neonatology, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Martínez
authors.forename: Narcis
authors.initials: N
authors.lastname: Masoller
authors.forename: Roland
authors.initials: R
authors.lastname: Devlieger
authors.forename: Esther
authors.initials: E
authors.lastname: Passchyn
authors.forename: Olga
authors.initials: O
authors.lastname: Gómez
authors.forename: Joan
authors.initials: J
authors.lastname: Rodo
authors.forename: Jan A
authors.initials: JA
authors.lastname: Deprest
authors.forename: Eduard
authors.initials: E
authors.lastname: Gratacós
mesh_terms: D000328:Adult; D003558:Cystoscopy / Q000379:methods*; D005260:Female; D005313:Fetal Death; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D005332:Fetoscopy / Q000379:methods*; D005865:Gestational Age; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D011247:Pregnancy; D016216:Ultrasonography, Prenatal; D014521:Urethra / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D014522:Urethral Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D014524:Urethral Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000601:surgery