Vesico-Amniotic Shunting in Fetal Posterior Urethral Valve Syndrome / 대한산부인과학회잡지

Fetal posterior urethral valve syndrome results in potentially lethal complications including renal dysplasia, pulmonary hypoplasia. Antenatal fetal vesicocentesis and amniotic fluid infusion may be useful to improve neonatal pulmonary function, however rapid recurrence of urinary retention and oligohydramnios usually required repetitive invasive procedures. We successfully treated a posterior urethral valve syndrome with vesico-amniotic shunt. Under ultrasonographic guidence, we inserted a Double-Basket Catheter into fetal urinary bladder through lower abdominal wall at second trimester. Shunt remained in place until the fetus was delivered at 35th gestational week. The vesico-amniotic shunt can improve fetal outcome and avoid repeated vesicocentesis before delivery.

Fetal vesico-amniotic shunting procedure (VASP) for posterior urethral valve syndrome at 19weeks' gestation / 대한산부인과학회잡지

An ultrasonographic examination revealed increased fetal bladder size and decreased AFI as well as fetal bilateral hydronephrosis at 173weeks' gestation. Diagnosis of the fetal posterior urethral valve syndrome was made. Percutaneous fetal bladder puncture with aspiration and amniocentesis was performed. The fetus was normal male karyotype and with a predicted good renal function(sodium concentration, chloride concentration, and osmolarity at 74 mEq/L, 60 mEq/L, and 148 mOsm, respectively). So, the fetus underwent amnioinfusion and vesico-amniotic shunting procedure (VASP) using a double-basket catheter at 194weeks' gestation in order to prevent development of dysplastic kidneys and hypoplastic lungs. The healthy male baby was delivered at 384weeks' gestation and had normally functioning kidney. Cutaneous vesicostomy was performed for the newborn since the urethral orifice was small. The one year old infant is now well and waiting for urethroscopic valve ablation procedure.

In-utero fetal therapy of posterior urethral valve syndrome: A case of vesicoamniotic shunting using a basket-shaped catheter / 대한산부인과학회잡지

We present a case of in-utero treatment of posterior urethral valve syndrome(PUVS) by vesicoamniotic shunting. The shunt was established by basket-shaped catheter at the 22 weeks' gestation. Enlarged bladder and hydronephrosis were improved after the shunt procedure. The baby was delivered at the 39 weeks' gestation and had normal serum range of BUN and creatinine. Because the outer opening of catheter was burried under abdominal skin on the day before delivery, posterior urethral valve excision and basket removal through urethra were operated by endoscopy on the 2nd day of birth. The baby has been followed up for 5 months and in good health. We report this case with a brief review of literature. Shunt operation in-utero is considered as a safe and effective therapy for lower urinary tract obstruction caused by PUVS.