Early fetal cystoscopy for first-trimester severe megacystis

R. Ruano, C. T. Yoshisaki, E. M.A. Salustiano, A. M. Giron, M. Srougi, M. Zugaib

Research output: Contribution to journalArticle

38 Scopus citations

Abstract

Objectives 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.

Original languageEnglish (US)
Pages (from-to)696-701
Number of pages6
JournalUltrasound in Obstetrics and Gynecology
Volume37
Issue number6
DOIs
StatePublished - Jun 1 2011

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Keywords

  • cystoscopy
  • fetal lower urinary tract obstruction
  • fetal surgery
  • laser therapy
  • megacystis
  • posterior urethral valves
  • urethral atresia
  • vesicoamniotic shunt

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Reproductive Medicine
  • Radiology Nuclear Medicine and imaging
  • Obstetrics and Gynecology

Cite this

Ruano, R., Yoshisaki, C. T., Salustiano, E. M. A., Giron, A. M., Srougi, M., & Zugaib, M. (2011). Early fetal cystoscopy for first-trimester severe megacystis. Ultrasound in Obstetrics and Gynecology, 37(6), 696-701. https://doi.org/10.1002/uog.8963