[Factors associated with the survival of fetuses with a prenatal diagnosis of megabladder]. / Factores asociados a sobrevida de fetos con diagnóstico prenatal de megavejiga.

The presence of fetal megacystis in a renal ultrasound may suggest a mechanical or functional bladder outlet obstruction, an uncommon condition with a poor outcome. OBJECTIVE: To determine prog nostic factors in fetuses with prenatal diagnosis of megacystis. PATIENTS AND METHOD: Retrospective study carried out between 2003 and 2018 in the Orient Perinatal Reference Center (CERPO), Uni versity of Chile. Prenatal and postnatal data were analyzed, as well as etiology, pulmonary hypoplasia, medical and surgical treatment, mortality, renal function, and need for renal replacement therapy. The primary variable analyzed was survival at one year, and the secondary ones were renal function and predictors of survival. Statistical analysis was performed using the Mann-Whitney U tests or Fisher test, and a p < 0.05 was considered statistically significant. RESULTS: Twenty-five fetuses with prenatal diagnosis of megacystis were included. 52% of them presented oligohydramnios and 84% showed renal anomalies. Vesicocentesis was performed in 15 fetuses and vesicoamniotic shunt was performed in 5 cases. There were 6 intrauterine fetal deaths (24%) and, among the 19 live births, 9 died soon after birth (36%) and 1 died in the post-neonatal period due to a non-nephron-urological cause. Nine newborns survived by one year of age (36%), seven of them with associated nephron- urological anomaly, and two were healthy patients. Two patients developed chronic kidney disease. The presence of pulmonary hypoplasia was the only factor associated with increased perinatal mor tality (p<0.05) secondary to oligohydramnios in all cases. Oligohydramnios was not identified as a prognostic factor in this study. CONCLUSIONS: The prenatal diagnosis of megacystis comprises a wide spectrum of pathologies including conditions with a high perinatal mortality rate to healthy fetuses with transient enlarged bladder without nephron-urological pathology. The only factor associated with increased perinatal mortality was pulmonary hypoplasia.

In-hospital resource utilization, outcome analysis and radiation exposure in children undergoing appendicostomy vs cecostomy tube placement.

INTRODUCTION AND OBJECTIVES: Continence enemas for the purpose of bowel management may be delivered via trans-anal retrograde irrigations, and via antegrade conduits including surgical appendicostomy or placement of cecostomy tube (CT). An appreciation of the relative advantages and disadvantages of each antegrade continence enema (ACE) procedure allows clinicians, parents and children to make an informed decision regarding which procedure is most appropriate in individual cases. The objective of this study was to evaluate the differences in in-hospital resource utilization, surgical outcomes and radiation exposure between children undergoing appendicostomy creation and CT placement at our institution. METHODS: We conducted a retrospective chart review of children undergoing these procedures at our institution over a 10-year period. All patients 0-18 years of age undergoing either procedure for any indication were included. Data on demographics, length of stay (LOS), radiation exposure events (REE), and surgical outcomes were collected. RESULTS: One hundred fifteen (63 appendicostomy/52 CT) patients were included. Those undergoing CT placement had significantly increased post-procedural LOS, catheter exchanges and REE compared to those undergoing appendicostomy (see Table). Reported rates of bowel control were similar between the two groups, and there was no significant difference in rates of surgical complications, although each group had unique, procedure-specific complications. DISCUSSION AND CONCLUSION: In our study, appendicostomy holds a clear advantage over CT in terms of post-procedural LOS, as well as REE. In general, children with CTs require more planned and unplanned device maintenance procedures than those with appendicostomy. These findings aside, the rates of success for bowel control between the two groups are similar, and the incidence of complications does not differ significantly between the two groups. CT remains a safe and effective conduit for delivery of ACEs, and is a particularly good option in patients whose appendix has been lost or used for another conduit. However, patients wishing to avoid repeated procedures and radiation exposure may find the option of appendicostomy more attractive.