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Andrew H Chon, Gustavo H de Oliveira, Kevin V Lemley, Lisa M Korst, Ryan D Assaf, Ramen H Chmait
INTRODUCTION: Although mortality has decreased for fetuses with lower urinary tract obstruction treated with vesicoamniotic shunt (VAS) placement, survivors remain at risk for long-term renal impairment. We tested the association of fetal serum β2-microglobulin (fsβ2M) with postnatal renal function in these patients, hypothesizing that fsβ2M may predict such renal impairment. MATERIALS AND METHODS: fsβ2M was obtained in patients undergoing VAS placement. The primary outcome was renal function at 3-12 months of life, as assessed by a pediatric nephrologist using medical records...
September 8, 2016: Fetal Diagnosis and Therapy
R Stadié, B Strizek, I Gottschalk, A Geipel, U Gembruch, C Berg
OBJECTIVE: To examine the outcome of fetuses with megacystis treated with vesicoamniotic shunting (VAS) from 14 weeks onward. METHODS: Retrospective review of all fetuses that received VAS at two centres from 2004 to 2012. RESULTS: 53 fetuses with megacystis were included in the study. Mean gestational age at diagnosis was 16.4 weeks. Mean gestational age at first shunt placement was 17.8 weeks. The first shunt placement was performed before 16 weeks in 18 (34 %) cases...
July 9, 2016: Archives of Gynecology and Obstetrics
Venu Jain, Sujata Chandra, Darcie A Kiddoo
No abstract text is available yet for this article.
April 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Sina Haeri, David H Simon, Kartik Pillutla
Fetal lower urinary tract obstruction (LUTO) encompasses a heterogeneous group of congenital pathologies and generally results in oligohydramnios. Fetal intervention (e.g. vesicoamniotic shunting, fetal cystoscopy) has traditionally been reserved for cases with a favorable renal profile, while those with unfavorable renal function have been offered termination or expectant management with the latter leading to high incidence of marked pulmonary hypoplasia, neonatal morbidity and mortality. Here, we describe two cases, which were not candidates for traditional intervention based on abnormal fetal renal function, who elected to proceed with serial amnioinfusions for fetal pulmonary palliation to attenuate the risk of pulmonary hypoplasia...
March 29, 2016: Journal of Maternal-fetal & Neonatal Medicine
Rodrigo Ruano, Nicolas Sananes, Clark Wilson, Jason Au, Chester J Koh, Patricio Gargollo, Alireza A Shamshirsaz, Jimmy Espinoza, Adnan Safdar, Amirhossein Moaddab, Nicolas Meyer, Darrell L Cass, Oluyinka O Olutoye, Olutoyin A Olutoye, Stephen Welty, David R Roth, Michael C Braun, Michael A Belfort
OBJECTIVES: To present a single center experience of a standardized prenatal multidisciplinary management protocol for fetal lower urinary tract obstruction (LUTO) and to propose a classification of fetal LUTO based on disease severity. METHODS: This is a retrospective cohort study of 25 consecutive fetal patients with prenatal diagnosis of primary LUTO. Fetal intervention was offered after evaluation by a multidisciplinary team. Analyses were conducted using Bayesian methodology...
December 22, 2015: Ultrasound in Obstetrics & Gynecology
M O Akkurt, A Yavuz, M Sezik, M O Ozkaya
No abstract text is available yet for this article.
2016: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
Paolo Sala, Federico Prefumo, Daniela Pastorino, Davide Buffi, Chiara Roberta Gaggero, Marilena Foppiano, Pierangela De Biasio
In utero fetal surgery interventions are currently considered in selected cases of congenital diaphragmatic hernia, cystic pulmonary abnormalities, amniotic band sequence, selected congenital heart abnormalities, myelomeningocele, sacrococcygeal teratoma, obstructive uropathy, and complications of twin pregnancy. Randomized controlled trials have demonstrated an advantage for open fetal surgery of myelomeningocele and for fetoscopic selective laser coagulation of placental vessels in twin-to-twin transfusion syndrome...
April 2014: Obstetrical & Gynecological Survey
Rk Morris, Lj Middleton, Gl Malin, E Quinlan-Jones, Jp Daniels, Ks Khan, Jj Deeks, Md Kilby
OBJECTIVE: Describe the influences on decision making in fetal lower urinary tract obstruction (LUTO) and identify prenatal prognostic features. METHODS: The PLUTO study included a registry of cases of isolated LUTO with conservative management or vesicoamniotic shunting (VAS). Logistic regression analysis examined prognostic features affecting outcome. For comparison of effectiveness the outcomes were survival to 2 years and renal function. RESULTS: 45 women were registered, 78% (35/45) received conservative management...
June 2014: Archives of Disease in Childhood. Fetal and Neonatal Edition
Anne-Claude Müller Brochut, Daniel Thomann, Wolfram Kluwe, Edoardo Di Naro, Anette Kuhn, Luigi Raio
OBJECTIVES: Megacystis (MC) is rare and often associated with other structural and chromosomal anomalies. In euploid cases with early oligohydramnios, prognosis is poor mainly due to pulmonary hypoplasia and renal damage. We report our experience of the past 20 years. METHODS: A retrospective review of cases with prenatally diagnosed MC was performed. Complete prenatal as well as postnatal medical records from 1989 to 2009 were reviewed focusing on diagnostic precision, fetal interventions [vesicocentesis (VC), vesicoamniotic shunt (VAS)], short- and long-term outcome, and potential prognostic factors...
2014: Fetal Diagnosis and Therapy
Mark D Kilby, R Katie Morris
Lower urinary tract obstruction (LUTO) comprises a heterogeneous group of pathologies associated with early-onset oligohydramnios and cystic renal disease that have high rates of perinatal morbidity (from renal disease) and mortality (from pulmonary hypoplasia). The use of prenatal detailed ultrasonography and fetal urine analysis has been only partially successful in identifying fetuses with LUTO with relatively good prognosis that would benefit from in utero therapy. The most common prenatal therapy is vesicoamniotic shunting...
July 2014: Nature Reviews. Urology
Lea Tuzovic, Kwame Anyane-Yeboa, Ashley Mills, Kenneth Glassberg, Russell Miller
OBJECTIVE: To investigate prenatal ultrasonographic findings associated with megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS). METHODS: A PubMed search was performed using the terms 'MMIHS', 'MMIH' and 'prenatal diagnosis'. RESULTS: A total of 50 cases were analyzed. Prenatal diagnosis was achieved in 26% of cases. In 54% of patients with a correct antenatal diagnosis there was a previously affected sibling. Fetal megacystis with or without hydroureteronephrosis was the most common initial ultrasonographic finding (88%)...
2014: Fetal Diagnosis and Therapy
R Ruano, C T Yoshizaki, A M Giron, M Srougi, M Zugaib
We report the case of a fetus with severe megabladder, displaying the 'keyhole' sign on ultrasound imaging, that underwent cystoscopy at 22 weeks' gestation. There was a familial history of mild urethral atresia. Fetal cystoscopy revealed congenital urethral atresia. A guide wire was advanced through the fetal urethra and a transurethral vesicoamniotic stent was placed successfully. The fetus was delivered at 36 weeks' gestation and postnatal cystoscopy confirmed the absence of posterior urethral valves or urethral atresia...
August 2014: Ultrasound in Obstetrics & Gynecology
R K Morris, G L Malin, E Quinlan-Jones, L J Middleton, L Diwakar, K Hemming, D Burke, J Daniels, E Denny, P Barton, T E Roberts, K S Khan, J J Deeks, M D Kilby
BACKGROUND: Congenital lower urinary tract obstruction (LUTO) is a disease associated with high perinatal mortality and childhood morbidity. Fetal vesicoamniotic shunting (VAS) bypasses the obstruction with the potential to improve outcome. OBJECTIVE: To determine the effectiveness, cost-effectiveness and patient acceptability of VAS for fetal LUTO. DESIGN: A multicentre, randomised controlled trial incorporating a prospective registry, decision-analytic health economic model and preplanned Bayesian analysis using elicited opinions...
December 2013: Health Technology Assessment: HTA
Douglass B Clayton, John W Brock
No abstract text is available yet for this article.
November 2013: Nature Reviews. Urology
Rachel K Morris, Gemma L Malin, Elisabeth Quinlan-Jones, Lee J Middleton, Karla Hemming, Danielle Burke, Jane P Daniels, Khalid S Khan, Jon Deeks, Mark D Kilby
BACKGROUND: Fetal lower urinary tract obstruction (LUTO) is associated with high perinatal and long-term childhood mortality and morbidity. We aimed to assess the effectiveness of vesicoamniotic shunting for treatment of LUTO. METHODS: In a randomised trial in the UK, Ireland, and the Netherlands, women whose pregnancies with a male fetus were complicated by isolated LUTO were randomly assigned by a central telephone and web-based randomisation service to receive either the intervention (placement of vesicoamniotic shunt) or conservative management...
November 2, 2013: Lancet
Cecilia G Ethun, Irving J Zamora, David R Roth, Arundhati Kale, Lars Cisek, Michael A Belfort, Sina Haeri, Rodrigo Ruano, Stephen E Welty, Christopher I Cassady, Oluyinka O Olutoye, Darrell L Cass
PURPOSE: The purpose of this manuscript was to examine the outcomes of patients with lower urinary tract obstruction (LUTO) treated with vesicoamniotic shunt (VAS) to improve the quality of prenatal consultation and therapy. METHODS: The medical records of all patients diagnosed with LUTO at our center between January 2004 and March 2012 were reviewed retrospectively. RESULTS: Of 14 male fetuses with LUTO, all with characteristic ultrasound findings, 11 underwent intervention...
May 2013: Journal of Pediatric Surgery
Casey L Gregory, Jane Wright, Jessica Schwarz, Laura Rakowski
Fetal anomalies such as lower urinary tract obstructions and fluid-filled space-occupying lesions in the fetal chest can result in severe morbidity or mortality if left untreated. In-utero fetal shunt placement offers the potential to improve outcomes in infants with these conditions. The role of the nurse is paramount in the clinical and psychosocial management of the mother and family.
May 2012: Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN
Douglass B Clayton, John W Brock
The burgeoning use of prenatal ultrasonography has prompted discussion of the feasibility and capabilities of fetal intervention for urologic disorders. On the basis of the capabilities of fetal intervention, three prenatally diagnosed anomalies are of primary interest to urologists: congenital adrenal hyperplasia (CAH), lower urinary tract obstruction (LUTO) and myelomeningocele. Various interventions (surgical or pharmacological) are being developed for fetuses with these diagnoses. For fetuses with CAH or LUTO, successful outcomes have certainly been demonstrated, although no results from prospective randomized trials have been published...
April 2012: Nature Reviews. Urology
R J Humphrey, T Grieci, J Schmidt, R Gagnon, V Han, A Bütter
OBJECTIVES: To determine the feasibility of fetoscopic vesicoamniotic shunt insertion (F-VASI) in an inanimate model and to compare F-VASI to ultrasound (US)-guided VASI (US-VASI) with respect to accuracy of shunt placement and overall success rate. METHODS: An inanimate second-trimester fetus with a replaceable bladder balloon was suspended in a pressurized water tank and localized with US. Fetal position was randomized, the operator was blinded and a 5-Fr Harrison Shunt® decompressed the bladder in both groups...
2011: Fetal Diagnosis and Therapy
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