Federica Fontanella1, Leonie Duin2, Phebe N Adama van Scheltema3, Titia E Cohen-Overbeek4, Eva Pajkrt5, Mireille Bekker6,7, Christine Willekes8, Caroline J Bax9, Dick Oepkes3, Catia M Bilardo2. 1. Department of Obstetrics, Gynecology and Prenatal Diagnosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlandsfederica.fontanella@gmail.com. 2. Department of Obstetrics, Gynecology and Prenatal Diagnosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 3. Department of Obstetrics, Gynecology and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands. 4. Department of Obstetrics, Gynecology and Prenatal Diagnosis, Erasmus MC University Medical Center, Rotterdam, The Netherlands. 5. Department of Obstetrics, Gynecology and Prenatal Diagnosis, Academic Medical Center Amsterdam, Amsterdam, The Netherlands. 6. Department of Obstetrics, Gynecology and Prenatal Diagnosis, Radboud University Medical Center, Nijmegen, The Netherlands. 7. Department of Obstetrics, Gynecology and Prenatal Diagnosis, University Medical Center Utrecht, Utrecht, The Netherlands. 8. Department of Obstetrics, Gynecology and Prenatal Diagnosis, University Medical Center, Grow School for Oncology and Medical Biology, Maastricht, The Netherlands. 9. Department of Obstetrics, Gynecology and Prenatal Diagnosis, VU University Medical Center, Amsterdam, The Netherlands.
Abstract
OBJECTIVE: To investigate the best criteria for discriminating fetuses with isolated posterior urethral valves from those theoretically not eligible for fetal treatment because of complex megacystis, high chance of spontaneous resolution, and urethral atresia. METHODS: A retrospective national study was conducted in fetuses with megacystis detected before 17 weeks' gestation (early megacystis). RESULTS: In total, 142 cases with fetal megacystis were included in the study: 52 with lower urinary tract obstruction, 29 with normal micturition at birth, and 61 with miscellaneous syndromal associations, chromosomal and multiple structural abnormalities (complex megacystis). Only a nuchal translucency > 95th centile, and not a longitudinal bladder diameter ≤15 mm (p = 0.24), significantly increased the risk of complex megacystis (p < 0.01). Cases with a high chance of spontaneous resolution were identified by using the cut-off of 12 mm, as demonstrated in a previous study, and the finding of an associated umbilical cord cyst carried a high-risk of urethral atresia (odds ratio: 15; p = 0.026), an unfavorable condition for antenatal treatment. An algorithm encompassing these three criteria demonstrated good accuracy in selecting fetuses theoretically eligible for fetal treatment (specificity 73%; sensitivity 92%). CONCLUSIONS: Cases theoretically eligible for early fetal therapy are those with normal nuchal translucency, a longitudinal bladder diameter > 12 mm, and without ultrasound evidence of umbilical cord cysts.
OBJECTIVE: To investigate the best criteria for discriminating fetuses with isolated posterior urethral valves from those theoretically not eligible for fetal treatment because of complex megacystis, high chance of spontaneous resolution, and urethral atresia. METHODS: A retrospective national study was conducted in fetuses with megacystis detected before 17 weeks' gestation (early megacystis). RESULTS: In total, 142 cases with fetal megacystis were included in the study: 52 with lower urinary tract obstruction, 29 with normal micturition at birth, and 61 with miscellaneous syndromal associations, chromosomal and multiple structural abnormalities (complex megacystis). Only a nuchal translucency > 95th centile, and not a longitudinal bladder diameter ≤15 mm (p = 0.24), significantly increased the risk of complex megacystis (p < 0.01). Cases with a high chance of spontaneous resolution were identified by using the cut-off of 12 mm, as demonstrated in a previous study, and the finding of an associated umbilical cord cyst carried a high-risk of urethral atresia (odds ratio: 15; p = 0.026), an unfavorable condition for antenatal treatment. An algorithm encompassing these three criteria demonstrated good accuracy in selecting fetuses theoretically eligible for fetal treatment (specificity 73%; sensitivity 92%). CONCLUSIONS: Cases theoretically eligible for early fetal therapy are those with normal nuchal translucency, a longitudinal bladder diameter > 12 mm, and without ultrasound evidence of umbilical cord cysts.
Authors: Jean-Marie Jouannic; Jon A Hyett; Pranav P Pandya; Béatrice Gulbis; Charles H Rodeck; Eric Jauniaux Journal: Prenat Diagn Date: 2003-04 Impact factor: 3.050
Authors: F Qureshi; S M Jacques; B Feldman; B J Doss; A Johnson; M I Evans; M P Johnson Journal: Fetal Diagn Ther Date: 2000 Nov-Dec Impact factor: 2.587
Authors: L S Bernardes; G Aksnes; J Saada; V Masse; C Elie; Y Dumez; S L Lortat-Jacob; A Benachi Journal: Ultrasound Obstet Gynecol Date: 2009-10 Impact factor: 7.299
Authors: Rachel K Morris; Gemma L Malin; Elisabeth Quinlan-Jones; Lee J Middleton; Karla Hemming; Danielle Burke; Jane P Daniels; Khalid S Khan; Jon Deeks; Mark D Kilby Journal: Lancet Date: 2013-08-14 Impact factor: 79.321
Authors: Valentina Capone; Nicola Persico; Alfredo Berrettini; Stèphane Decramer; Erika Adalgisa De Marco; Diego De Palma; Alessandra Familiari; Wout Feitz; Maria Herthelius; Vytis Kazlauskas; Max Liebau; Gianantonio Manzoni; Michal Maternik; Giovanni Mosiello; Joost Peter Schanstra; Johan Vande Walle; Elke Wühl; Elisa Ylinen; Aleksandra Zurowska; Franz Schaefer; Giovanni Montini Journal: Nat Rev Urol Date: 2022-02-08 Impact factor: 16.430