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WS07: Fetal endoscopy and invasive procedures
WS07‐01Fetal hydrolaparoscopy and endoscopic cystotomy in complicated cases of lower urinary tract obstruction
Author(s) -
Quintero R. A.,
Bornick P. W.,
Morales W. J.,
Allen M. H.,
Johnson P. K.
Publication year - 2000
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1046/j.1469-0705.2000.00009-1-44.x
Subject(s) - medicine , surgery , shunting , cystoscopy , obstructive uropathy , endoscopy , shunt (medical) , oligohydramnios , complication , fetus , urinary system , anatomy , pregnancy , genetics , biology
Background Vesicoamniotic shunting may be difficult or impossible in selected cases of fetal lower obstructive uropathy (LOU). The purpose of this paper is to describe the performance of fetal hydrolaparoscopy (FHL) and endoscopic fetal cystotomy (EFC) in fetuses with complicated LOU. Method FHL‐EFC was performed in one patient with a markedly thickened bladder that could not be entered percutaneously. A peritoneoamniotic shunt was also placed. FHL‐EFC was performed in a second patient with a collapsed bladder from a previous vesicocentesis, as vesicoinfusion resulted in further ascites. Fetal cystoscopy was performed after EFC, and posterior urethral valves were ablated with YAG‐laser. A vesicoamniotic shunt was inserted. Results Adequate bladder drainage was obtained in both cases. The first baby required bilateral nephrostomies and a permanent cystotomy at birth, and is scheduled for a bladder expansion procedure at one year of age. The second patient had premature rupture of membranes and fetal demise from treatment of this complication 5 days after the original procedure. Conclusion FHL‐EFC can be performed in complicated LOU cases. The procedure involves the creation of a defect in the bladder dome under direct endoscopic visualization within a hydroperitoneum. Peritoneo or vesicoamniotic shunting, or ablation of posterior urethral valves may then be performed. FHL‐EFC should be reserved only for complicated cases of LOU where conventional vesicoamniotic shunting is not possible.