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Effects of early vesicostomy in obstructive uropathy on bladder development
Yuriko Sato1, Hiroaki Kitagawa, Kevin C Pringle
1Division of Pediatric Surgery, St Marianna University School of Medicine, Kawasaki, Japan.
Journal of Pediatric Surgery
|December 24, 2004
Summary
Fetal urinary tract obstruction and shunting can lead to abnormal bladder development. Even successful shunts may result in poor bladder compliance and fibrosis, impacting long-term function.
Area of Science:
- Fetal surgery
- Urology
- Developmental biology
Background:
- Obstructive uropathy in fetuses disrupts normal urination.
- The impact of vesico-amniotic shunting on fetal bladder development is not well understood.
Purpose of the Study:
- To assess fetal bladder volume and histology after creating obstructive uropathy and subsequent shunting.
- To understand the effects of bypassing fetal urinary obstruction on bladder function.
Main Methods:
- Obstructive uropathy was induced in fetal lambs by urethral and urachal ligation.
- Vesicostomy/urethrostomy was performed to relieve obstruction.
- Bladder volume and histology were examined at term (145 days gestation).
Main Results:
- Shunted fetuses showed variable outcomes, with some developing very small bladders and others large bladders due to shunt failure.
- Histological examination revealed bladder muscle hypertrophy from obstruction and severe fibrosis with poor compliance in shunted bladders.
- Successful shunting did not restore normal bladder function.
Conclusions:
- Urinary diversion via shunting may preserve renal function but compromises bladder development.
- A normal fetal urination cycle is crucial for proper bladder development, even when urinary obstruction is bypassed.
- Shunt operations for fetal obstructive uropathy require further investigation to optimize bladder outcomes.