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. 2023 Mar;39(3):227-233.
doi: 10.1051/medsci/2023030. Epub 2023 Mar 21.

[In utero surgery for lower urinary tract obstruction]

[Article in French]
Nicolas Vinit  1 , Yves Ville  2 , Thomas Blanc  1
Affiliations
Free article

[In utero surgery for lower urinary tract obstruction]

[Article in French]
Nicolas Vinit et al. Med Sci (Paris). 2023 Mar.
Free article

Abstract
in English, French

Prenatal therapy for LUTO (Lower Urinary Tract Obstruction) is debated due to mixed results regarding postnatal renal function following fetal cystoscopy or vesicoamniotic shunting. Current literature is, however, limited by the inability to determine the cause of the obstruction using plain sonography and the lack of selection criteria for fetuses who may benefit from prenatal therapy. Fetal cystoscopy may serve as a diagnostic tool and would offer a more "physiologic" treatment for bladder outlet obstruction. However, it carries additional technical issues due to inappropriate instrumentation.

Title: Prise en charge prénatale des obstacles sous-vésicaux.

Abstract: Les résultats du traitement prénatal des obstacles sous-vésicaux sont souvent mitigés en termes de bénéfices sur la fonction rénale. Devant le diagnostic prénatal de mégavessie1 fœtale persistante, aucun signe échographique ne permet actuellement de déterminer avec certitude la cause de l’obstacle. La cystoscopie fœtale, qui consiste en l’exploration endoscopique de la vessie, pourrait permettre de déterminer la nature de l’obstacle et de le traiter éventuellement, en maintenant le cycle de réplétion/vidange vésicale. L’absence de critères de sélection des fœtus candidats à la cystoscopie fœtale et les difficultés techniques de sa réalisation limitent cependant son utilisation. Nous présentons dans cette revue les principes de cette intervention, les résultats obtenus et les limites, ainsi que les axes de recherches actuels.

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References

    1. Sebire NJ, Von Kaisenberg C, Rubio C, et al. Fetal megacystis at 10–14 weeks of gestation. Ultrasound Obstet Gynecol 1996 ; 8 : 387–390.
    1. Fontanella F, Duin L, Adama van Scheltema PN, et al. Fetal megacystis: prediction of spontaneous resolution and outcome. Ultrasound Obstet Gynecol 2017 ; 50 : 458–463.
    1. Fontanella F, Maggio L, Verheij JBGM, et al. Fetal megacystis: a lot more than LUTO. Ultrasound Obstet Gynecol 2019 ; 53 : 779–787.
    1. Taghavi K, Sharpe C, Stringer MDFetal megacystis: A systematic review. J Pediatr Urol 2017 ; 13 : 7–15.
    1. Fontanella F, Duin LK, Adama van Scheltema PN, et al. Prenatal diagnosis of LUTO: improving diagnostic accuracy. Ultrasound Obstet Gynecol 2018 ; 52 : 739–743.

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