Fetal bladder rupture: A systematic review and management recommendations
Jonathan Aichner1, Tobias Jhala2, Philipp Szavay1
1Department for Pediatric Surgery, Children's Hospital of Central Switzerland, Lucerne 16, 6000, Switzerland.
Insights
Prenatal bladder rupture, a rare condition, often requires intervention for lower urinary tract obstruction. Management varies, but conservative approaches with catheter drainage and ascites management are often successful, though surgical options exist.
Area of Science:
- Urology
- Pediatric Surgery
- Neonatology
Background:
- Prenatal bladder rupture is a rare congenital anomaly.
- Limited data and textbook coverage pose diagnostic and management challenges.
Purpose of the Study:
- To provide clinical recommendations for managing prenatal bladder rupture.
- To synthesize current knowledge on this condition.
Main Methods:
- Systematic review of PubMed, Embase, and Science Direct databases.
- Adherence to PRISMA guidelines and JBI checklist.
- Analysis of 28 cases from 27 eligible publications.
Main Results:
- Associated with lower urinary tract obstruction and maternal opioid use.
- Defect variability, prenatal resolution, and diverse neonatal presentations (asymptomatic to requiring life support).
- Conservative management (bladder drainage, ascites management) often leads to spontaneous closure; surgery is an alternative if conservative methods fail.
Conclusions:
- Management is variable, necessitating multidisciplinary decision-making.
- Favorable outcomes are generally reported, but follow-up data are often limited.
- Further research is needed to establish evidence-based guidelines for prenatal bladder rupture.
Introduction:
Prenatal bladder rupture is a rare condition. The lack of data and coverage in textbooks presents significant challenges for its diagnosis and management.
Objective:
This study aims to offer recommendations to assist clinicians dealing with this condition.
Study Design:
A systematic review was conducted by searching PubMed, Embase, and Science Direct databases, following PRISMA guidelines and using the JBI checklist. Search terms included "prenatal" or "fetal" "bladder rupture," "prenatal" or "fetal" "urinary ascites" as well as "bladder rupture and opioids". The search identified 2156 publications, which were screened; 27 were eligible for inclusion, allowing for a total of 28 cases to be analyzed.
Discussion:
Although the data quality and reporting were heterogeneous, several key findings emerged: Prenatal bladder rupture is associated with lower urinary tract obstruction and has also been reported in cases involving maternal opioid use. Defects vary significantly and may resolve prenatally. At birth, some infants required extensive life support and immediate ascites drainage while others are asymptomatic. Postnatally, conservative management with drainage of the bladder, preferably via a transurethral catheter, and ascites management will likely lead to a spontaneous closure of the defect. If conservative management fails, surgical closure may be achieved via laparotomy or laparoscopy. Outcomes were generally reported to be favorable, though follow-up data were often insufficient.
Conclusion:
The review highlights the variability in management of prenatal bladder rupture, emphasizing the need for multidisciplinary decision-making and further research to establish evidence-based guidelines.
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