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[Vesico-amniotic shunt-therapy in fetal obstructive uropathy]
T H Nguyen1, J M Thorup, T Larsen
1Amtssygehuset i Herlev, ultralydafdelingen.
Ugeskrift for Laeger
|September 23, 1996
Summary
Prenatal diagnosis of posterior urethral valve via ultrasound enabled in utero treatment with a vesicoamniotic shunt. This intervention successfully preserved kidney function in a one-year-old infant.
Area of Science:
- Perinatology
- Pediatric Surgery
- Fetal Medicine
Background:
- Prenatal diagnosis of congenital anomalies is increasing due to widespread obstetric ultrasound use.
- Some fetal malformations are amenable to in utero treatment, improving outcomes.
- Posterior urethral valve (PUV) is a significant cause of congenital kidney disease.
Observation:
- A fetus at 17 weeks gestation presented with a diagnosed posterior urethral valve.
- Ultrasound revealed a dilated bladder, bilateral hydronephrosis, and oligohydramnios, indicative of severe PUV.
- These findings suggested a risk of developing dysplastic kidneys and hypoplastic lungs.
Findings:
- An ultrasonically guided vesicoamniotic shunt was successfully placed in utero at 24 weeks gestation.
- The shunt aimed to decompress the fetal urinary tract and prevent irreversible kidney and lung damage.
- Postnatal transurethral valve resection was performed at five months of age.
Implications:
- Successful prenatal intervention for posterior urethral valve can prevent severe renal dysplasia.
- Fetal intervention preserves lung development by mitigating oligohydramnios.
- This case highlights the efficacy of in utero management for improving long-term outcomes in infants with PUV.