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fetal bladder outlet obstruction

Gihad E Chalouhi, Anne-Maude Morency, Roland De Vlieger, José Maria Martinez, Thomas Blanc, Ryan Hodges, Alexandra Gueneuc, Greg Ryan, Jan Deprest, Eduard Gratacos, Yves Ville
We reviewed data from a cohort of fetuses with ureterocele diagnosed and operated prenatally in four fetal therapy centers. Inclusion criteria were (1) ureterocele confirmed on detailed fetal ultrasound examination, (2) absence of additional fetal malformations, and (3) fetal intervention to decompress the ureterocele with local institutional review boards' approval. Data on sonographic follow-up, obstetrical, neonatal outcome, and postnatal evaluation were collected. Ten cases of prenatally treated ureterocele are described...
October 2017: Prenatal Diagnosis
M K Farrugia, M C Braun, C A Peters, R Ruano, C D Herndon
INTRODUCTION: The Society for Fetal Urology panel section at the 2016 Fall Congress featured a multidisciplinary discussion on appropriate patient selection, the conservative versus surgical management, and postnatal renal outcome of fetuses with lower urinary tract obstruction (LUTO). SELECTION CRITERIA FOR INTERVENTION: Rodrigo Ruano shared his experience of prenatal intervention, presenting the outcome of 111 fetuses with severe LUTO treated with vesicoamniotic shunting (VAS) (n = 16), cystoscopy (n = 34) or no intervention (n = 61) in a non-randomized series...
August 2017: Journal of Pediatric Urology
Michael C Carr
No abstract text is available yet for this article.
October 2017: Journal of Pediatric Urology
Jitu W George, Amanda L Patterson, Pradeep S Tanwar, André Kajdacsy-Balla, Gail S Prins, Jose M Teixeira
Nearly all older men will experience lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH), the etiology of which is not well understood. We have generated Stk11 CKO mice by conditional deletion of the liver kinase B1 (LKB1) tumor suppressor gene, Stk11 (serine threonine kinase 11) , in the fetal Müllerian duct mesenchyme (MDM), the caudal remnant of which is thought to be assimilated by the urogenital sinus primordial mesenchyme in males during fetal development. We show that MDM cells contribute to the postnatal stromal cells at the dorsal aspect of the prostatic urethra by lineage tracing...
March 28, 2017: Proceedings of the National Academy of Sciences of the United States of America
N Persico, A Berrettini, I Fabietti, C Dallagiovanna, D Minoli, F Mosca, L Fedele, G Manzoni
Prenatal ultrasound detection of fetal ureterocele with bilateral hydroureteronephrosis, obstruction of the bladder outlet and progressive amniotic fluid reduction have been associated with a significant risk of end-stage chronic renal disease after birth. Fetal cystoscopic laser incision of the ureterocele, using standard 3.5-mm fetoscopic access to the amniotic cavity and the fetal bladder with the aim of relieving the bladder outflow obstruction to preserve renal function, has been reported previously in a case with a favorable outcome...
July 2017: Ultrasound in Obstetrics & Gynecology
Marie-Klaire Farrugia
Fetal bladder outlet obstruction (BOO), most commonly caused by posterior urethral valves (PUV), remains a challenging and multi-faceted condition. Evolving techniques, and refinement in ultrasound, optics and instrumentation, have increased our rate of prenatal diagnosis, and enabled valve ablation not only in smaller newborns, but also in fetuses. Long-term outcome studies have raised our awareness of the silent damage caused by bladder dysfunction and polyuria and encouraged their proactive management. In spite of our best efforts, the proportion of boys with PUV who progress to chronic and end-stage renal disease (ESRD) has not changed in the last 25 years...
October 2016: Journal of Pediatric Urology
Nicolas Sananes, Rogelio Cruz-Martinez, Romain Favre, Ricardo Ordorica-Flores, Raphaël Moog, Ariane Zaloszy, Amilcar Martins Giron, Rodrigo Ruano
OBJECTIVES: Our objective is to report long-term outcome after fetal cystoscopy for lower urinary tract obstruction (LUTO), as well as to investigate the accuracy of fetal cystoscopy in diagnosing the cause of bladder outlet obstruction. METHODS: This is a retrospective cohort study of all fetuses who underwent cystoscopy for prenatal diagnosis of LUTO in three tertiary referral centers. Fetal diagnostic cystoscopy was performed to determine prenatally the cause of LUTO and to ablate the posterior urethral valves (PUV)...
April 2016: Prenatal Diagnosis
X Torres Montebruno, J M Martinez, E Eixarch, O Gómez, L García Aparicio, M Castañón, E Gratacos
We report on the successful use of fetoscopic surgery to treat a case of prolapsed ureterocele in a female fetus. At 21 weeks' gestation, a double renal system with an intravesical ureterocele obstructing the bladder outlet was diagnosed, causing severe megacystis, bilateral hydronephrosis and progressive oligohydramnios. Ultrasound evaluation following referral to our center confirmed severe bilateral hydronephrosis with pelvic and calyceal dilatation, but amniotic fluid volume was normal and the ureterocele was not visualized in the bladder...
November 2015: Ultrasound in Obstetrics & Gynecology
Lucile Fievet, Alice Faure, Stéphanie Coze, Luke Harper, Nicoleta Panait, David Braunstein, James Carson, Guillaume Gorincour, Kathia Chaumoitre, Jean-Michel Guys, Pierre Alessandrini, Claude D'Ercole, Thierry Merrot
OBJECTIVE: To describe the diagnostic criteria and outcome of fetal megacystis according to the gestational age at diagnosis. METHODS: A 7-year retrospective study was carried out from 2004 to 2011, including cases of megacystis referred to 2 prenatal fetal medicine units. The following data were collected and analyzed: maternal age, term at diagnosis (gestational weeks), ultrasonographic and magnetic resonance imaging data, karyotype, decision of the multidisciplinary prenatal team, fetopathology in cases of termination of pregnancy or fetal death, final diagnosis at birth after ultrasonography and voiding cystourethrography, and medical and surgical follow-up...
July 2014: Urology
Silaja Yitta, Payam Saadai, Roy A Filly
The fetal urinoma is a rare but important diagnosis, as it indicates substantial underlying obstruction with implications for the functionality of the affected kidney. This case series describes a single center's experience with the diagnosis and management of fetal urinomas. All 25 cases were diagnosed or referred to our medical center over an 11-year period. Most cases were secondary to either posterior urethral valves or ureteropelvic junction obstruction. Fetal interventions, including percutaneous drainage of the urinoma and cystoscopic alleviation of bladder outlet obstruction, were performed in 4 cases...
January 2014: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Josef Oswald, Isabel Heidegger, Eberhard Steiner, Erich Brenner, Michael Ladurner Rennau, Renate Pichler, Tanja Becker, Wolfgang Loidl, Wolfgang Horninger, Helga Fritsch
OBJECTIVE: To investigate the fetal development of the internal urethral sphincter and the gender-related morphologic differences of the bladder outlet. MATERIALS AND METHODS: Thirty-seven (14 female, 23 male) fetal bladder neck specimens (mean gestational age, 19.4 weeks) with the smooth muscle complex of the internal sphincter were investigated histologically. After immunostaining serial sections in 3 reference planes (sagittal, frontal, and horizontal) of the bladder neck, the internal sphincter volumes and bladder outlet diameters were measured and correlated with gender and age of gestation...
December 2013: Urology
Hiroaki Kitagawa, Yasuji Seki, Hideki Nagae, Takeshi Aoba, Shutaro Manabe, Kei Ooyama, Junki Koike, Masayuki Takagi, Jane Zuccollo, Shinobu Tatsunami, Kevin C Pringle
PURPOSE: A valved ventriculo-peritoneal shunt (V-P shunt) as a vesico-amniotic shunt (V-A shunt) preserves the filling/emptying cycle and normal bladder development in fetal lambs with bladder outlet obstruction. The optimal pressure for such shunts is unknown. MATERIALS AND METHODS: We created obstructive uropathy in 60-day gestation fetal lambs. A V-A shunt was placed 3 weeks later, using a low-pressure (Group L: 15-54 mmH2O) or a high-pressure (Group H: 95-150 mmH2O) V-P shunt...
April 2013: Pediatric Surgery International
Lin Yang, Runming Liu, Xinyang Wang, Dalin He
UNLABELLED: What's known on the subject? and what does the study add?: A decrease in bladder compliance is known to be correlated with deterioration of renal function after bladder outlet obstruction (BOO). Increased deposition of extracellular matrix (ECM) in the detrusor layer is the primary reason for decreased compliance. In the bladder, as in other organs, ECM deposition is dependent on the balanced activity of proteolytic enzymes, including matrix metalloproteinases (MMPs) and their endogenous inhibitors, tissue inhibitors of metalloproteinases (TIMPs)...
August 2013: BJU International
Daniel P Casella, Jeffrey J Tomaszewski, Michael C Ost
Posterior urethral valves occur in 1 : 5000 live births. Despite the high prevalence, the few children that survive do poorly, with over 50% progressing to ESRD in 10 years. The gold standard for post-natal diagnosis is voiding cystourethrography, while pre-natal diagnosis is dependent on routine screening ultrasonography. Despite the ability to identify features of bladder outlet obstruction early in fetal development, there is no consensus on how to incorporate early detection into current screening protocols...
2012: International Journal of Nephrology
Kazuki Kitajima, Takeshi Aoba, Kevin C Pringle, Yasuji Seki, Jane Zuccollo, Junki Koike, Tatsuya Chikaraishi, Hiroaki Kitagawa
BACKGROUND: Lower urinary tract obstruction causes both renal failure and bladder dysfunction after birth. This study examined the early bladder wall changes after creating an obstructive uropathy focusing on bladder wall thickness and muscle integrity. METHODS: We created obstructive uropathy in fetal lambs at 60 days' gestation, ligating the urethra and urachus. The fetuses (n = 28) were delivered at 48 hours and 3, 4, 5, 7, and 14 days after obstruction and at term (145 days' gestation)...
December 2010: Journal of Pediatric Surgery
Stephen D Confer, Vincenzo Galati, Dominic Frimberger, Bradley P Kropp
Fetal megacystis, an abnormally enlarged bladder identified at any gestational age, may be transient and resolve spontaneously or may be an early manifestation of bladder outlet obstruction. Anterior urethral valves are the most common cause of the rare condition of congenital obstruction of the anterior urethra. Herein is reported the prenatal observation and postnatal management of a case of megacystis with anterior urethral valves. The etiology is reviewed and strategies recommended for patients with these rare entities...
October 2010: Journal of Pediatric Urology
D Camanni, A Zaccara, M L Capitanucci, C Brizzi, L Mobili, C Giorlandino, G Mosiello, M De Gennaro
OBJECTIVE: Oligohydramnios (OA) is nowadays regarded as one of the best markers of renal function (RF) impairment in bladder outlet obstruction (BOO) detected in utero. As such, its onset is usually early and progressive because of decline in fetal urine production. A series of acute OA complicating pregnancies with BOO has never been reported. METHODS: Over a 7-year period, 5 fetuses with in utero suspicion of BOO exhibited an abrupt decrease of amniotic fluid after the 30th week of gestation...
2009: Fetal Diagnosis and Therapy
Stacy T Tanaka, Magaly Martinez-Ferrer, John H Makari, Marcia L Wills, John C Thomas, Mark C Adams, John W Brock, John C Pope, Neil A Bhowmick
PURPOSE: Bladder fibrosis is an undesired end point of partial bladder outlet obstruction. In fibrotic disease of the lung, kidney, skin and heart chemokines recruit bone marrow derived cells to injured tissue. Blockade of chemokines like CCL2 results in decreased fibrosis in other organs. To our knowledge we present the first report of bone marrow derived cell recruitment to the bladder in a murine bladder outlet obstruction model. MATERIALS AND METHODS: We lethally irradiated WT female mice and reconstituted their bone marrow using fetal liver cells from transgenic mice ubiquitously expressing green fluorescent protein...
October 2009: Journal of Urology
Omer Acar, Nihat Uluocak, Orhan Ziylan, Ibrahim Kalelioğlu, Atil Yüksel, Haluk Ander
PURPOSE: We investigated the prognostic power of cystatin C to determine renal functional outcome in patients with prenatally diagnosed infravesical obstruction. MATERIALS AND METHODS: A total of 14 fetuses with ultrasound findings of bladder outlet obstruction were enrolled in the study. Amniotic fluid and fetal urine samples were obtained. Controls consisted of 25 fetuses undergoing amniocentesis for obstetrical reasons. Three consecutive bladder punctures were performed to obtain fetal urine samples...
October 2009: Journal of Urology
Joseph R Siebert, Martin P R Walker
BACKGROUND: We report the familial recurrence of urethral stenosis/atresia in two sibling fetuses with bladder outlet obstruction, severe oligohydramnios, and pulmonary hypoplasia. Urethral obstruction in the fetus, when severe, results in a dilated urinary bladder (megacystis) and associated urinary anomalies (hydroureter, hydronephrosis, renal dysplasia). Distention of the fetal abdomen, the result of megacystis or urinary ascites, leads to stretching and eventually hypoplasia or even absence of abdominal muscles...
August 2009: Birth Defects Research. Part A, Clinical and Molecular Teratology
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