ABSTRACT
Fetal intervention has progressed in the past two decades from experimental proof-of-concept to practice-adopted, life saving interventions in human fetuses with congenital anomalies. This progress is informed by advances in innovative research, prenatal diagnosis, and fetal surgical techniques. Invasive open hysterotomy, associated with notable maternal-fetal risks, is steadily replaced by less invasive fetoscopic alternatives. A better understanding of the natural history and pathophysiology of congenital diseases has advanced the prenatal regenerative paradigm. By altering the natural course of disease through regrowth or redevelopment of malformed fetal organs, prenatal regenerative medicine has transformed maternal-fetal care. This review discusses the uses of regenerative medicine in the prenatal diagnosis and management of three congenital diseases: congenital diaphragmatic hernia, lower urinary tract obstruction, and spina bifida.
Subject(s)
Fetal Diseases/surgery , Fetoscopy/history , Hernias, Diaphragmatic, Congenital , Spinal Dysraphism , Urethral Stricture/surgery , Animals , Fetoscopy/methods , Hernias, Diaphragmatic, Congenital/embryology , Hernias, Diaphragmatic, Congenital/surgery , History, 20th Century , History, 21st Century , Humans , Patient Selection , Prenatal Diagnosis , Spinal Dysraphism/embryology , Spinal Dysraphism/surgery , Urethral Stricture/embryologyABSTRACT
A newborn male infant presented with the "renal nonfunction syndrome" and subsequently was found at autopsy to have congenital stenosis of the posterior urethra. Additional urinary tract malformations included a prostatic diverticulum, bladder hypertrophy, bilateral hydroureter, and bilateral renal hypoplasia with dysplasia. Autopsy evidence suggested that the urethral stenosis had manifested itself very early during embryologic development and accounted for the associated urinary anomalies. The infant had the physical stigmata, clinical course, and pulmonary hypoplasia commonly observed in "Potter's" or the "renal nonfunction syndrome."
Subject(s)
Abnormalities, Multiple , Kidney Diseases/congenital , Urethral Stricture/congenital , Urinary Tract/abnormalities , Humans , Infant, Newborn , Male , Syndrome , Urethral Stricture/embryology , Urethral Stricture/pathology , Urinary Tract/pathologySubject(s)
Urethra/abnormalities , Bulbourethral Glands/embryology , Cysts/congenital , Cysts/diagnosis , Cysts/embryology , Cysts/therapy , Diverticulum/congenital , Diverticulum/diagnosis , Diverticulum/embryology , Diverticulum/therapy , Female , Genital Diseases, Male/congenital , Genital Diseases, Male/diagnosis , Genital Diseases, Male/embryology , Genital Diseases, Male/therapy , Humans , Infant, Newborn , Male , Urethra/embryology , Urethral Diseases/congenital , Urethral Diseases/diagnosis , Urethral Diseases/embryology , Urethral Diseases/therapy , Urethral Stricture/congenital , Urethral Stricture/diagnosis , Urethral Stricture/embryology , Urethral Stricture/therapyABSTRACT
Seven cases of anterior urethral stricture were studied. The diagnosis was made by exclusion of the inflammatory and traumatic causes. In three cases the stricture was located in the bulbar and in four cases in the penile urethra. The results obtained were good, with a follow-up of 5 to 50 months. Considerations are made about embryogenic, diagnostic, clinical picture and treatment. The verification of extensive lesions of the urethra determined the use of more complex surgical techniques of Johansen's urethroplasty devised for the treatment of this kind of pathology.
