open access

Vol 88, No 9 (2017)
Research paper
Published online: 2017-09-29
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Early vesico-amniotic shunting — does it change the prognosis in fetal lower urinary tract obstruction diagnosed in the first trimester?

Marzena Dębska, Piotr Kretowicz, Anna Olędzka, Piotr Gastoł, Joanna Dangel, Małgorzata Świątkowska-Freund, Romuald Dębski
DOI: 10.5603/GP.a2017.0089
·
Pubmed: 29057434
·
Ginekol Pol 2017;88(9):486-491.

open access

Vol 88, No 9 (2017)
ORIGINAL PAPERS Obstetrics
Published online: 2017-09-29

Abstract

Objectives: The aim of the study was to assess the outcome of vesico-amniotic shunting performed before 16 weeks of pregnancy in fetuses with severe megacystis diagnosed in the first trimester of pregnancy.

Material and methods: Between January 2008 and October 2012 severe megacystis with the bladder length > 15 mm was diagnosed in 17 fetuses. The procedure of early vesico-amniotic shunting (VAS) was offered to 8 patients with presumably isolated LUTO. The procedure of VAS was performed in 6 fetuses. Before the intervention one or two procedures of vesicocentesis and urine analysis were performed.

Results: In all treated cases shunts provided urinary tract decompression. All babies were born prematurely, 2 of them died due to premaurity, 3 of them survived and have normal renal function at the age of 5–6 years. In 4/5 children accompanying malformations were later diagnosed, in 1 born prematurely neonate necropsy was not performed.

Conclusions: Our results suggest that early vesico-amniotic shunting in fetal LUTO is feasible and may potentially prevent not only pulmonary hypoplasia but also renal insufficiency. However, the rationale of the procedure needs further investigation due to a high risk of long-term morbidity and co-existing malformations in children Before offering the therapy detailed counseling of the parents about the possible pros and cons of the therapy is necessary.

Abstract

Objectives: The aim of the study was to assess the outcome of vesico-amniotic shunting performed before 16 weeks of pregnancy in fetuses with severe megacystis diagnosed in the first trimester of pregnancy.

Material and methods: Between January 2008 and October 2012 severe megacystis with the bladder length > 15 mm was diagnosed in 17 fetuses. The procedure of early vesico-amniotic shunting (VAS) was offered to 8 patients with presumably isolated LUTO. The procedure of VAS was performed in 6 fetuses. Before the intervention one or two procedures of vesicocentesis and urine analysis were performed.

Results: In all treated cases shunts provided urinary tract decompression. All babies were born prematurely, 2 of them died due to premaurity, 3 of them survived and have normal renal function at the age of 5–6 years. In 4/5 children accompanying malformations were later diagnosed, in 1 born prematurely neonate necropsy was not performed.

Conclusions: Our results suggest that early vesico-amniotic shunting in fetal LUTO is feasible and may potentially prevent not only pulmonary hypoplasia but also renal insufficiency. However, the rationale of the procedure needs further investigation due to a high risk of long-term morbidity and co-existing malformations in children Before offering the therapy detailed counseling of the parents about the possible pros and cons of the therapy is necessary.

Get Citation

Keywords

first trimester scan, fetal megacystis, early vesico-amniotic shunting, LUTO, renal function

About this article
Title

Early vesico-amniotic shunting — does it change the prognosis in fetal lower urinary tract obstruction diagnosed in the first trimester?

Journal

Ginekologia Polska

Issue

Vol 88, No 9 (2017)

Article type

Research paper

Pages

486-491

Published online

2017-09-29

DOI

10.5603/GP.a2017.0089

Pubmed

29057434

Bibliographic record

Ginekol Pol 2017;88(9):486-491.

Keywords

first trimester scan
fetal megacystis
early vesico-amniotic shunting
LUTO
renal function

Authors

Marzena Dębska
Piotr Kretowicz
Anna Olędzka
Piotr Gastoł
Joanna Dangel
Małgorzata Świątkowska-Freund
Romuald Dębski

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