In-utero percutaneous cystoscopy in the management of fetal lower obstructive uropathy

• Published in: The Lancet (British edition) Vol. 346; no. 8974; pp. 537 - 540
• Main Authors: Quintero, R.A, Johnson, M.P, Romero, R, Cotton, D.B, Evans, M.I, Smith, C, Arias, F, Guevara-Zuloaga, F
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 26.08.1995; Lancet; Elsevier Limited
• Subjects: Amniotic Fluid; Anastomosis, Surgical; Biological and medical sciences; Bladder; Cystoscopes; Cystoscopy; Dilatation, Pathologic - diagnosis; Dilatation, Pathologic - surgery; Endoscopes; Female; Fetal Diseases - diagnosis; Fetal Diseases - surgery; Fetus - surgery; Fetuses; Fiber Optic Technology - instrumentation; Gestational Age; Humans; Male; Medical research; Medical sciences; Mucosa; Needles; Orifices; Pregnancy; Prenatal Diagnosis; Punctures; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Ultrasound; Ureteral Obstruction - diagnosis; Ureteral Obstruction - surgery; Urethra; Urethral Obstruction - diagnosis; Urethral Obstruction - surgery; Urinary Bladder - surgery; Urinary Bladder Neck Obstruction - diagnosis; Urinary Bladder Neck Obstruction - surgery; Urinary Catheterization; Urologic Diseases - diagnosis; Urologic Diseases - surgery; Urology; Human; Endoscopic surgery; Urinary system disease; Cystoscopy; Urinary tract disease; Congenital disease; Obstruction; Percutaneous route; Treatment; Malformation; Surgery; Fetus; Age
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(95)91381-5

Summary In fetuses with lower obstructive uropathy, sonography cannot establish the cause of obstruction. We assessed whether percutaneous fetal cystoscopy could be useful in the evaluation and treatment of obstructive defects in utero. We inserted a fibreoptic endoscope through the lumen of the needle or trocar into the fetal bladder at the time of vesicocentesis or vesicoamniotic-shunt placement and looked at the the urethra, bladder neck, and ureteral orifices. Urethral vesicoamniotic shunting was considered in suitable cases; otherwise a percutaneous shunt was inserted. Fetal cystoscopy was possible in 11 of 13 patients referred. The bladder mucosa appeared haemorrhagic or oedematous in three. The ureteral orifices were seen in 9/11 fetuses, dilation was seen in five, but was only suspected in two by ultrasound. Ureteral webs were noted in two other fetuses. Two of seven fetuses underwent urethral vesicoamniotic shunting; urethral patency was achieved with urethral probing alone in one fetus. The remaining four fetuses were shunted with a standard technique. Fetal cystoscopy helps define the underlying conditions responsible for sonographic findings of lower obstructive uropathy, and allows the introduction of new treatments.