Jose Pierro

34 statements · 1 topic

Featured statements

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.
quote · Posterior Urethral Valves
According to Elder et al. 1987, complications of vesico-amniotic shunting include blockage, shunt migration (common as fetuses pull or dislodge the shunt), preterm delivery, urinary ascites, chorioamnionitis, iatrogenic gastroschisis, and abdominal or inguinal herniation.
clinical · Posterior Urethral Valves

Nothing matches these filters — clear the search or widen the filters.

Jose's statements about Posterior Urethral Valves 34 statements

Open the Posterior Urethral Valves collection →

Prenatal intervention for Fetal Urinary Tract Obstruction

Statement Prenatal diagnosis of fetal urinary tract obstruction requires ultrasound assessment of keyhole sign, bladder thickness, amniotic fluid volume, and fetal sex. Open
Quotation The first thing is that to offer any fetal therapy, we need to make a good diagnosis. Open
Quotation If it's a male and potential posterior urethral valves. Open
Statement In male fetuses, posterior urethral valves can be diagnosed prenatally and are amenable to fetal intervention. Open
Quotation 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. Open
Statement Fetal urinary tract obstruction causes pulmonary hypoplasia due to anhydramnios, renal insufficiency from obstructive nephropathy creating renal dysplasia, and bladder dysfunction from distended bladder without cycling. Open
Statement Therapeutic goals for fetal urinary tract obstruction target three organs: lungs (restore amniotic fluid for normal development), kidneys (decompress obstruction), and bladder (restore detrusor cycling contractions). Open
Quotation To treat the lungs, we will need to restore the amniotic fluid around the baby to enhance normal lung development. Open
Statement Fetal renal function assessment is based on bladder tap for fetal urine analysis, ultrasound evaluation of renal parenchyma for cystic dysplasia, and bladder refilling after bladder tap. Open
Quotation 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. Open
Quotation 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. Open
Statement Bladder refilling after vesicocentesis demonstrates that the fetus has the ability to make urine. Open
Statement 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. Open
Statement In moderate or borderline renal dysplasia where kidneys make small amounts of urine, intervention may be too late to save kidney function but can save the lungs and provide option for renal transplant. Open
Statement In cases with no renal dysplasia where kidneys make plenty of urine, intervention can theoretically save both kidney function and lungs. Open
Statement Fetal intervention techniques for urinary tract obstruction include percutaneous (bladder aspiration, shunt placement, infusions), fetoscopic (cystoscopy with ureteral catheterization or valve ablation), and open surgery (vesicostomy or cutaneous ureterostomies). Open
Statement Common vesico-amniotic shunt devices include Rodeck, Harrison, Cook, and Summaex (more commonly used in Europe). Open
Statement Overall survival with vesico-amniotic shunting is approximately 50%, and of survivors, 40% will eventually develop end-stage renal disease. Open
Statement According to Elder et al. 1987, complications of vesico-amniotic shunting include blockage, shunt migration (common as fetuses pull or dislodge the shunt), preterm delivery, urinary ascites, chorioamnionitis, iatrogenic gastroschisis, and abdominal or inguinal herniation. Open
Statement Vesico-amniotic shunt placement has 98% technical success rate but 15% complication rate, with complications carrying 100% mortality due to loss of amniotic fluid. Open
Statement Open fetal surgery for urinary tract obstruction has limitations including need for deep general anesthesia, maternal laparotomy and hysterotomy, and increased maternal and fetal risk with more prematurity. Open
Statement Dr. Crombleholme and Dr. Lim at Cincinnati attempted open fetal vesicostomy with minimal uterine exposure, creating a hole in the abdominal wall and marsupializing the bladder for drainage, allowing spontaneous postnatal closure. Open
Statement In Cincinnati Children's Hospital series, 6 male fetuses at 19-22 weeks gestational age with anhydramnios and normal fetal urine electrolytes underwent open vesicostomy with complete postnatal urinary decompression, no maternal complications, but only 2 of 6 survived. Open
Statement The main challenge with fetal cystoscopy for posterior urethral valves is the angulation difficulty in visualizing and accessing the posterior urethral valves during surgery. Open
Statement Cincinnati Children's uses mini-laparotomy approach for fetal cystoscopy with T-fasteners to bring tissue layers together for improved visualization of posterior urethral valves. Open
Statement Transurethral catheter can be placed in combination with laser therapy for posterior urethral valve treatment, using wire to identify and access valves followed by laser ablation and catheter deployment. Open
Statement In a study by Ruano et al., fetal cystoscopy showed 60% survival compared to 10% in control group. Open
Statement A 2019 VA study found no difference between VA shunting and fetal cystoscopy regarding chronic kidney disease or survival. Open
Statement Fetal cystoscopy appeared to decrease the incidence of chronic kidney disease in patients with posterior urethral valves in one study. Open
Statement According to Ruano et al. 2015 study, fetal cystoscopy had 66% survival, VA shunting had 60% survival, and control group had 17% survival. Open
Statement In the only published study on amnio-port technique, there were no cases of fetal death related to the procedure, complete restoration of amniotic fluid occurred in all cases, but 6 of 8 fetuses still had pulmonary hypoplasia at birth. Open
Statement Amnio-port is a metal port used for intravascular medication and parenteral nutrition that can be implanted inside the uterus for easy subcutaneous access for fluid replacement. Open
Statement Methods for restoring amniotic fluid include repeated serial amnio-infusions (initially once weekly, progressing to twice weekly in late gestation) or placement of an amnio-port. Open
Statement For fetuses with kidney dysplasia and minimal urine output who are not candidates for shunt or cystoscopy, the only option is attempting pulmonary rescue by restoring amniotic fluid from outside. Open