E-ISSN: 2619-9467

Contents    Cover    Publication Date: 06 Jun 2023
Year 2023 - Volume 33 - Issue 2

Open Access

Peer Reviewed

ORIGINAL RESEARCH
584 Viewed642 Downloaded

Evaluation of Vesicocentesis Procedure in Patients with Megacystis: A Retrospective Analysis

Full Text PDF  
JCOG. 2023;33(2):95-102
DOI: 10.5336/jcog.2022-95065
Article Language: EN
Copyright Ⓒ 2020 by Türkiye Klinikleri. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: To evaluate the patients who underwent vesicocentesis for fetal megacystis. Material and Methods: Patients who underwent vesicocentesis between May 2021 and May 2022 in İzmir Tepecik Training and Research Hospital's Perinatology Department were evaluated retrospectively. Data were collected from the hospital database. Demographic characteristics of patients, indications, laboratory findings, clinical outcomes, and complications of vesicocentesis procedure were evaluated. Results: Vesicocentesis was performed in 25 patients with fetal megacystis. The mean age of the population was 27.6 years (range: 20-36 years) and the mean gestational week at the time of procedure was 18.9 weeks (range: 13-31 weeks). Hydronephrosis was observed in 6 (24%) patients. Multiple organ malformations were observed in 5 (20%) patients. Genetic examination was performed for all fetuses. CHRM3 gene mutation and Prune-belly syndrome were found in 1 (4%) patient. The mean values of the markers examined by vesicocentesis were found as follows: sodium (104.1 mg/dL), chloride (91.5 mg/dL), osmolality (246.5 mOsm/L), calcium (6.4 mg/dL), total protein (35.2 mg/dL), and β2-microglobulin (9.6 mg/L). Vesicoamniotic shunt procedure was performed to 7 (28%) patients. In one (4%) patient, the shunt was reinserted because of the displacement into the intraamniotic cavity. After the vesicocentesis procedure, premature rupture of membranes or intrauterine bleeding did not develop, but one (4%) patient underwent cesarean delivery due to fetal distress. Conclusion: Vesicocentesis could provide information that can be useful when deciding whether a fetus with megacystis could benefit from vesicoamniotic shunting. However, the long-term effects of vesicoamniotic shunting on these fetuses need to be determined to establish the true clinical effectiveness and cost-effectiveness of the intervention.
REFERENCES:
  1. McHugo J, Whittle M. Enlarged fetal bladders: aetiology, management and outcome. Prenat Diagn. 2001;21(11):958-63. [Crossref]  [PubMed] 
  2. Taghavi K, Sharpe C, Stringer MD. Fetal megacystis: a systematic review. J Pediatr Urol. 2017;13(1):7-15. [Crossref]  [PubMed] 
  3. Haeri S. Fetal Lower Urinary Tract Obstruction (LUTO): a practical review for providers. Matern Health Neonatol Perinatol. 2015;1:26. [Crossref]  [PubMed]  [PMC] 
  4. Anumba DO, Scott JE, Plant ND, Robson SC. Diagnosis and outcome of fetal lower urinary tract obstruction in the northern region of England. Prenat Diagn. 2005;25(1):7-13. [Crossref]  [PubMed] 
  5. Lesieur E, Barrois M, Bourdon M, Blanc J, Loeuillet L, Delteil C, et al. Megacystis in the first trimester of pregnancy: Prognostic factors and perinatal outcomes. PLoS One. 2021;16(9):e0255890. [Crossref]  [PubMed]  [PMC] 
  6. Maymon R, Ben-Ami I, Vaknin Z, Reish O, Herman A. Is there an increased rate of megacystis in twins? Ultrasound Obstet Gynecol. 2005;26(2):197-9. [Crossref]  [PubMed] 
  7. Maizels M, Alpert SA, Houston JT, Sabbagha RE, Parilla BV, MacGregor SN. Fetal bladder sagittal length: a simple monitor to assess normal and enlarged fetal bladder size, and forecast clinical outcome. J Urol. 2004;172(5 Pt 1):1995-9. [Crossref]  [PubMed] 
  8. Wu CS, Chen CM, Chou HC. Pulmonary hypoplasia induced by oligohydramnios: findings from animal models and a population-based study. Pediatr Neonatol. 2017;58(1):3-7. [Crossref]  [PubMed] 
  9. Chen L, Guan J, Gu H, Zhang M. Outcomes in fetuses diagnosed with megacystis: Systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2019;233:120-6. [Crossref]  [PubMed] 
  10. Fontanella F, Maggio L, Verheij JBGM, Duin LK, Adama Van Scheltema PN, Cohen-Overbeek TE, et al. Fetal megacystis: a lot more than LUTO. Ultrasound Obstet Gynecol. 2019;53(6):779-87. [Crossref]  [PubMed]  [PMC] 
  11. Montemarano H, Bulas DI, Rushton HG, Selby D. Bladder distention and pyelectasis in the male fetus: causes, comparisons, and contrasts. J Ultrasound Med. 1998;17(12):743-9. [Crossref]  [PubMed] 
  12. Malin G, Tonks AM, Morris RK, Gardosi J, Kilby MD. Congenital lower urinary tract obstruction: a population-based epidemiological study. BJOG. 2012;119(12):1455-64. [Crossref]  [PubMed] 
  13. Bornes M, Spaggiari E, Schmitz T, Dreux S, Czerkiewicz I, Delezoide AL, et al. Outcome and etiologies of fetal megacystis according to the gestational age at diagnosis. Prenat Diagn. 2013;33(12):1162-6. [Crossref]  [PubMed] 
  14. Müller Brochut AC, Thomann D, Kluwe W, Di Naro E, Kuhn A, Raio L. Fetal megacystis: experience of a single tertiary center in Switzerland over 20 years. Fetal Diagn Ther. 2014;36(3):215-22. [Crossref]  [PubMed] 
  15. Favre R, Kohler M, Gasser B, Muller F, Nisand I. Early fetal megacystis between 11 and 15 weeks of gestation. Ultrasound Obstet Gynecol. 1999;14(6):402-6. [Crossref]  [PubMed] 
  16. Robyr R, Benachi A, Daikha-Dahmane F, Martinovich J, Dumez Y, Ville Y. Correlation between ultrasound and anatomical findings in fetuses with lower urinary tract obstruction in the first half of pregnancy. Ultrasound Obstet Gynecol. 2005;25(5):478-82. [Crossref]  [PubMed] 
  17. Kagan KO, Staboulidou I, Syngelaki A, Cruz J, Nicolaides KH. The 11-13-week scan: diagnosis and outcome of holoprosencephaly, exomphalos and megacystis. Ultrasound Obstet Gynecol. 2010;36(1):10-4. [Crossref]  [PubMed] 
  18. Fievet L, Faure A, Coze S, Harper L, Panait N, Braunstein D, et al. Fetal megacystis: etiologies, management, and outcome according to the trimester. Urology. 2014;84(1):185-90. [Crossref]  [PubMed] 
  19. Jouannic JM, Hyett JA, Pandya PP, Gulbis B, Rodeck CH, Jauniaux E. Perinatal outcome in fetuses with megacystis in the first half of pregnancy. Prenat Diagn. 2003;23(4):340-4. [Crossref]  [PubMed] 
  20. Sebire NJ, Von Kaisenberg C, Rubio C, Snijders RJ, Nicolaides KH. Fetal megacystis at 10-14 weeks of gestation. Ultrasound Obstet Gynecol. 1996;8(6):387-90. [Crossref]  [PubMed] 
  21. Irfan A, O'Hare E, Jelin E. Fetal interventions for congenital renal anomalies. Transl Pediatr. 2021;10(5):1506-17. [Crossref]  [PubMed]  [PMC] 
  22. Ruano R. Fetal surgery for severe lower urinary tract obstruction. Prenat Diagn. 2011;31(7):667-74. [Crossref]  [PubMed] 
  23. Nicolini U, Spelzini F. Invasive assessment of fetal renal abnormalities: urinalysis, fetal blood sampling and biopsy. Prenat Diagn. 2001;21(11):964-9. [Crossref]  [PubMed] 
  24. Evans MI, Sacks AJ, Johnson MP, Robichaux AG 3rd, May M, Moghissi KS. Sequential invasive assessment of fetal renal function and the intrauterine treatment of fetal obstructive uropathies. Obstet Gynecol. 1991;77(4):545-50. [PubMed] 
  25. Carroll SG, Soothill PW, Tizard J, Kyle PM. Vesicocentesis at 10-14 weeks of gestation for treatment of fetal megacystis. Ultrasound Obstet Gynecol. 2001;18(4):366-70. [Crossref]  [PubMed] 
  26. Liao AW, Sebire NJ, Geerts L, Cicero S, Nicolaides KH. Megacystis at 10-14 weeks of gestation: chromosomal defects and outcome according to bladder length. Ultrasound Obstet Gynecol. 2003;21(4):338-41. [Crossref]  [PubMed] 
  27. Ruano R, Yoshisaki CT, Salustiano EM, Giron AM, Srougi M, Zugaib M. Early fetal cystoscopy for first-trimester severe megacystis. Ultrasound Obstet Gynecol. 2011;37(6):696-701. [Crossref]  [PubMed] 
  28. Peyrière MP, Roth P, Combourieu D, Vavasseur C, Bouvier R, Guibaud L, et al. Étiologies et pronostic des mégavessies de diagnostic prénatal selon l'âge de découverte. Étude rétrospective sur six années [Aetiology and prognosis of prenatally diagnosed megacystis regarding gestational age at discovery. A six-year retrospective study]. Gynecol Obstet Fertil. 2010;38(11):663-7. French. [Crossref]  [PubMed] 
  29. Sepulveda W. Megacystis in the first trimester. Prenat Diagn. 2004;24(2):144-9. [Crossref]  [PubMed] 
  30. Nassr AA, Koh CK, Shamshirsaz AA, Espinoza J, Sangi-Haghpeykar H, Sharhan D, et al. Are ultrasound renal aspects associated with urinary biochemistry in fetuses with lower urinary tract obstruction? Prenat Diagn. 2016;36(13):1206-10. [Crossref]  [PubMed] 
  31. Ruano R, Dunn T, Braun MC, Angelo JR, Safdar A. Lower urinary tract obstruction: fetal intervention based on prenatal staging. Pediatr Nephrol. 2017;32(10):1871-8. [Crossref]  [PubMed] 
  32. Spaggiari E, Stirnemann JJ, Benedetti S, Dreux S, Salomon LJ, Blanc T, et al. Comparison of biochemical analysis of fetal serum and fetal urine in the prediction of postnatal renal outcome in lower urinary tract obstruction. Prenat Diagn. 2018. [Crossref]  [PubMed] 
  33. Morris RK, Malin GL, Quinlan-Jones E, Middleton LJ, Hemming K, Burke D, et al; Percutaneous vesicoamniotic shunting in Lower Urinary Tract Obstruction (PLUTO) Collaborative Group. Percutaneous vesicoamniotic shunting versus conservative management for fetal lower urinary tract obstruction (PLUTO): a randomised trial. Lancet. 2013;382(9903):1496-506. [Crossref]  [PubMed]  [PMC]