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Obstructive or non-obstructive megacystis: a prenatal dilemma.
Martina Mandaletti1,2, Elisa Cerchia1, Elena Ruggiero1,3
1Pediatric Urology Unit, Department of Public Health and Pediatric Sciences, Regina Margherita Children's Hospital, Turin, Italy.
Frontiers in Pediatrics
|July 17, 2024
Summary
Prenatal megacystis diagnosis, often linked to lower urinary tract obstruction (LUTO), has an 85% live birth rate. Current prenatal indicators do not predict postnatal outcomes or renal function.
Area of Science:
- Perinatology
- Fetal Medicine
- Pediatric Urology
Background:
- Prenatal diagnosis of megacystis significantly impacts pregnancy outcomes and fetal development.
- Distinguishing between obstructive and non-obstructive causes is crucial for predicting postnatal health.
- Adverse effects on fetal/neonatal survival and organ function necessitate further investigation.
Purpose of the Study:
- Investigate the natural history of fetal megacystis.
- Differentiate in utero congenital lower urinary tract obstruction (LUTO) from non-obstructive megacystis.
- Predict postnatal outcomes and renal function based on prenatal findings.
Main Methods:
- Retrospective observational study (July 2015-November 2023) of fetuses with specific bladder diameter criteria.
- Inclusion: longitudinal bladder diameter >7mm (1st trimester) or overdistended/thickened bladder failing to empty (2nd/3rd trimesters).
- Utilized ultrasound, genetic testing, prenatal counseling, and postnatal follow-up; stratified patients by diagnosis (LUTO, non-LUTO, normal urinary tract).
Main Results:
- 27 fetuses included (26 male); 92% diagnosed in 2nd/3rd trimesters.
- 85% live births (23 neonates), with 2 postnatal deaths due to malformations.
- No evaluated prenatal parameters (e.g., upper tract dilatation, keyhole sign, LBD, GA) predicted postnatal diagnosis or renal function.
Conclusions:
- Second/third-trimester megacystis diagnosis shows an 85% live birth rate, with LUTO as the primary cause.
- This outcome may be more favorable than previously reported, impacting prenatal counseling.
- Megacystis is a complex antenatal sign with varied prognoses beyond renal/respiratory risks.
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