Perinatology.  2024 Dec;35(4):140-145. 10.14734/PN.2024.35.4.140.

Implementation of Novel Fetal Intervention for Fetal Lower Urinary Tract Obstruction and the Importance of Candidate Selection: A Case Report

• Choi WS
• Ahn SY
• Lee NM
• Yu NL
• Ham S
• Kim GJ

• KMID: 2563892
• DOI: http://doi.org/10.14734/PN.2024.35.4.140

Abstract

Fetal lower urinary tract obstruction (LUTO) is a congenital condition in which the bladder fails to excrete urine through the urethra. The primary goal of prenatal treatment for LUTO is the prevention of renal impairment and pulmonary hypoplasia. Vesico-amniotic shunt (VAS) has been the fetal intervention of choice; however, VAS has some limitations, including excretion of urine through an unphysiologic bypass and the need for postnatal corrective reoperation. In this study, we present a novel fetal intervention, a “retro-cystoscopic urethral approach,” performed on a male fetus at 20 weeks gestation diagnosed with enlarged bladder and bilateral hydronephrosis. This approach aims to dilate the narrowed urethra by inserting a urinary catheter using guidewire through a fetal cysto scope. The whole procedure was monitored under real-time ultrasonographic guidance. Despite prenatal intervention, the fetus required multiple cystocenteses, and the bladder dilation persisted. Postnatally, he was diagnosed with megacystis microcolon intestinal hypoperistalsis syndrome, a non-obstructive condition which is relatively rare in male infants. Our case emphasizes the compl exity of diagnosing LUTO during the prenatal period. Further studies exploring novel prenatal interven tions should pay more attention to candidate selection. Additionally, a thorough evaluation of organ systems beyond the urinary tract is necessary.

Keyword

Fetoscopic Surgery; Fetal megacystis; Urethral obstruction; Ultrasonography; prenatal