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Jose's statements about Posterior Urethral Valves
29 statements
Open the Posterior Urethral Valves collection →
Prenatal intervention for Fetal Urinary Tract Obstruction
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Ep 6 · 0:19
quote
The first thing is that to offer any fetal therapy, we need to make a good diagnosis.
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Ep 6 · 0:19
clinical
Prenatal diagnosis of fetal urinary tract obstruction requires ultrasound assessment of keyhole sign, bladder thickness, amniotic fluid volume, and fetal sex.
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Ep 6 · 0:51
clinical
In male fetuses, posterior urethral valves can be diagnosed and are amenable to fetal intervention.
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Ep 6 · 0:51
quote
If it's a male and potential posterior urethral valves.
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Ep 6 · 1:12
quote
We have pulmonary hypoplasia because insufficient lungs as a result of the anidramius, renal insufficiency in many cases because this obstructive neuropathy creating renal dysplasia.
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Ep 6 · 1:12
clinical
Fetal urinary tract obstruction causes pulmonary hypoplasia due to anhydramnios (insufficient amniotic fluid leading to underdeveloped lungs).
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Ep 6 · 1:12
clinical
Obstructive nephropathy from urinary tract obstruction creates renal dysplasia, leading to renal insufficiency with associated morbidity, mortality, and need for transplant.
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Ep 6 · 1:12
clinical
A distended bladder without cycling contractions produces bladder dysfunction with infections and other problems postnatally.
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Ep 6 · 2:02
quote
To treat the lungs, we will need to restore the amniotic fluid around the baby to enhance normal lung development.
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Ep 6 · 2:02
clinical
Therapeutic goals for fetal urinary tract obstruction are to restore amniotic fluid (protect lungs), decompress the urinary system (protect kidneys), and allow detrusor cycling (protect bladder function).
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Ep 6 · 2:35
quote
We need to base our evaluation on the bladder tap using the fetal urine analysis, using the ultrasound to recognize the quality of the renal parenchyma and there is cystic dysplasia or not, and most importantly, In my opinion, the bladder refilling after the bladder tap.
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Ep 6 · 2:35
clinical
Renal function assessment in fetal urinary obstruction is based on bladder tap (fetal urine analysis), ultrasound evaluation of renal parenchyma for cystic dysplasia, and bladder refilling after bladder tap.
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Ep 6 · 3:06
quote
One side benefit of the bladder tap is if you actually aspirate out the urine and you see the bladder refill with urine again, you now know that the fetus has the ability to make urine.
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Ep 6 · 3:06
clinical
Bladder refilling after vesicocentesis demonstrates that the fetus has the ability to make urine.
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Ep 6 · 3:29
quote
We actually can see severe renal dysplasia where the baby makes no urine at all. We have no option to improve these kidneys at all. The only goal of the treatment will be a pulmonary survivor, to save the land by replacing the amniotic fluid also.
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Ep 6 · 3:29
clinical
In severe renal dysplasia where the fetus makes no urine, the only treatment goal is pulmonary survival by replacing amniotic fluid; kidney function cannot be improved.
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Ep 6 · 3:29
clinical
In moderate or borderline renal dysplasia where kidneys make small amounts of urine, intervention is likely too late to save kidney function but can save the lungs and provide the option of renal transplant.
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Ep 6 · 3:29
clinical
In cases with no renal dysplasia where kidneys make plenty of urine, decompressive techniques can theoretically rescue both kidney and lung function.
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Ep 6 · 5:04
clinical
Vesico-amniotic shunt devices commonly used include Rodeck, Harrison, Cook, and Summaex (more common in Europe).
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Ep 6 · 5:17
epidemiological
Overall survival with vesico-amniotic shunting is approximately 50%, and of survivors, 40% will develop end-stage renal disease.
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Ep 6 · 5:17
epidemiological
Vesico-amniotic shunt placement has a 98% technical success rate but a 15% complication rate, with complications carrying 100% mortality due to loss of amniotic fluid.
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Ep 6 · 7:15
clinical
Open fetal surgery for vesicostomy was attempted by Crombleholme and Lim in Cincinnati, using minimal uterine exposure to create an abdominal wall opening and marsupialize the bladder for drainage, allowing spontaneous postnatal closure.
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Ep 6 · 8:14
epidemiological
In the Cincinnati Children's Hospital series, 6 male fetuses between 19-22 weeks gestational age with anhydramnios and normal fetal urine electrolytes underwent open vesicostomy; all achieved complete postnatal urinary tract decompression, but only 2 of 6 survived, with no maternal complications.
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Ep 6 · 9:06
quote
Basically, the problem we have with fetal cystoscopy to attempt these posteriurethral valves is the angulation we have. We can access very well the bladder, but sometimes it's very difficult to see well, the orientation in the posteriral valves during the surgery.
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Ep 6 · 9:06
clinical
The main technical challenge with fetal cystoscopy for posterior urethral valves is the angulation; while bladder access is good, visualization and orientation of the posterior urethral valves during surgery can be difficult.
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Ep 6 · 10:08
clinical
Transurethral catheter placement can be combined with laser therapy for posterior urethral valve treatment; in one case at 23 weeks, a wire was used to identify and access valves, followed by laser ablation and transurethral catheter deployment.
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Ep 6 · 12:05
clinical
Amnio-port is a metal port used for intravascular medication and parenteral nutrition that can be implanted inside the uterus for easy subcutaneous access to replace amniotic fluid.
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Ep 6 · 12:05
clinical
For fetuses with kidney dysplasia and minimal urine output who are not candidates for shunt or cystoscopy, the only option is attempting lung rescue by placing fluid from outside to restore amniotic fluid.
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Ep 6 · 12:05
clinical
Methods for amniotic fluid restoration include repeated serial amnio-infusions with needle (once weekly initially, twice weekly in late gestation) or placement of an amnio-port.
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