Fetal cystoscopy in the management of fetal obstructive uropathy: experience in a single European centre

Welsh, Alec, Agarwal, Sanjiv, Kumar, Sailesh, Smith, Richard P. and Fisk, Nicholas M. (2003) Fetal cystoscopy in the management of fetal obstructive uropathy: experience in a single European centre. Prenatal Diagnosis, 23 13: 1033-1041. doi:10.1002/pd.717


Author Welsh, Alec
Agarwal, Sanjiv
Kumar, Sailesh
Smith, Richard P.
Fisk, Nicholas M.
Title Fetal cystoscopy in the management of fetal obstructive uropathy: experience in a single European centre
Journal name Prenatal Diagnosis   Check publisher's open access policy
ISSN 1097-0223
0197-3851
Publication date 2003-12-30
Year available 2003
Sub-type Article (original research)
DOI 10.1002/pd.717
Open Access Status
Volume 23
Issue 13
Start page 1033
End page 1041
Total pages 9
Place of publication Chichester, U.K..
Publisher Wiley
Language eng
Subject 111401 Foetal Development and Medicine
1103 Clinical Sciences
Abstract Objective To audit diagnostic and therapeutic fetal cystoscopy for suspected posterior urethral valves (PUV).
Formatted 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.
Copyright © 2003 John Wiley & Sons, Ltd.
Keyword Posterior urethral valves
Cystoscopy
Fetal therapy
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
 
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Created: Fri, 20 Mar 2009, 01:03:58 EST by Maria Campbell on behalf of Faculty Of Health Sciences