Laser Ablation of Posterior Urethral Valves by Fetal Cystoscopy

作者：Martinez Jose Maria; Masoller Narcis; Devlieger Roland; Passchyn Esther; Gomez Olga; Rodo Joan; Deprest Jan A; Gratacos Eduard^*

来源：Fetal Diagnosis and Therapy, 2015, 37(4): 267-273.

DOI：10.1159/000367805

• Fetal therapy
• Fetal cystoscopy
• Fetoscopy
• Lower urinary tract obstruction
• Posterior urethral valves
• Prenatal diagnosis

Objective: To report the results of fetal cystoscopic laser ablation of posterior urethral valves (PUV) in a consecutive series in two referral centers. Methods: Twenty pregnant women with a presumptive isolated PUV were treated with fetal cystoscopy under local anesthesia. Identification and fulguration of the PUV by one or several firing-contacts with diode laser were attempted. Perinatal and long-term outcomes were prospectively recorded. Results: The median gestational age at procedure was 18.1 weeks (range 15.0-25.6), and median operation time was 24 min (range 15-40). Access to the urethra was achieved in 19/20 (95%) cases, and postoperative, normalization of bladder size and amniotic fluid was observed in 16/20 (80%). Overall, there were 9 (45%) terminations of pregnancy and 11 women (55%) delivered a liveborn baby at a mean gestational age of 37.3 (29.1-40.2) weeks. No infants developed pulmonary hypoplasia and all were alive at 15-110 months. Eight (40% of all fetuses, 72.7% of newborns) had normal renal function and 3 (27.3%) had renal failure awaiting renal transplantation. Conclusion: Fetoscopic laser ablation for PUV can achieve bladder decompression and amniotic fluid normalization with a single procedure in selected cases with anyhydramnios. There is still a significant risk of progression to renal failure pre or postnatally.

• 出版日期2015