Martínez José María, Masoller Narcis, Devlieger Roland, Passchyn Esther, Gómez Olga, Rodo Joan, Deprest Jan A, Gratacós Eduard
BC Natal, Barcelona Center for Maternal-Fetal Medicine and Neonatology, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain.
Fetal Diagn Ther. 2015;37(4):267-73. doi: 10.1159/000367805. Epub 2015 Jan 21.
To report the results of fetal cystoscopic laser ablation of posterior urethral valves (PUV) in a consecutive series in two referral centers.
Twenty pregnant women with a presumptive isolated PUV were treated with fetal cystoscopy under local anesthesia. Identification and fulguration of the PUV by one or several firing-contacts with diode laser were attempted. Perinatal and long-term outcomes were prospectively recorded.
The median gestational age at procedure was 18.1 weeks (range 15.0-25.6), and median operation time was 24 min (range 15-40). Access to the urethra was achieved in 19/20 (95%) cases, and postoperative, normalization of bladder size and amniotic fluid was observed in 16/20 (80%). Overall, there were 9 (45%) terminations of pregnancy and 11 women (55%) delivered a liveborn baby at a mean gestational age of 37.3 (29.1-40.2) weeks. No infants developed pulmonary hypoplasia and all were alive at 15-110 months. Eight (40% of all fetuses, 72.7% of newborns) had normal renal function and 3 (27.3%) had renal failure awaiting renal transplantation.
Fetoscopic laser ablation for PUV can achieve bladder decompression and amniotic fluid normalization with a single procedure in selected cases with anyhydramnios. There is still a significant risk of progression to renal failure pre or postnatally.
报告在两个转诊中心对一系列连续性病例进行胎儿膀胱镜下后尿道瓣膜（PUV）激光消融的结果。
20例疑似孤立性PUV的孕妇在局部麻醉下接受胎儿膀胱镜检查。尝试通过与二极管激光进行一次或多次烧灼接触来识别并烧灼PUV。前瞻性记录围产期和长期结局。
手术时的中位孕周为18.1周（范围15.0 - 25.6周），中位手术时间为24分钟（范围15 - 40分钟）。20例中有19例（95%）成功进入尿道，术后16例（80%）观察到膀胱大小和羊水恢复正常。总体而言，有9例（45%）终止妊娠，11例（55%）孕妇分娩活婴，平均孕周为37.3周（29.1 - 40.2周）。无婴儿发生肺发育不全，所有婴儿在15 - 110个月时均存活。8例（占所有胎儿的40%，新生儿的72.7%）肾功能正常，3例（27.3%）患有肾衰竭，等待肾移植。
对于部分羊水过少的病例，胎儿镜下激光消融PUV可通过单次手术实现膀胱减压和羊水恢复正常。产前或产后进展为肾衰竭的风险仍然很大。
