Pierucci Ugo Maria, Paraboschi Irene, Lanfranchi Giulia, Peycelon Matthieu, Pelizzo Gloria, Ruano Rodrigo
Department of Pediatric Surgery, Ospedale Dei Bambini Vittore Buzzi, Milan, Italy.
Department of Biomedical and Clinical Sciences, University of Milano, Milan, Italy.
Prenat Diagn. 2025 Jan;45(1):89-101. doi: 10.1002/pd.6721. Epub 2024 Dec 18.
Fetal lower urinary tract obstruction (LUTO) encompasses a spectrum of rare congenital anomalies affecting the fetal urinary system, leading to significant morbidity and mortality. This condition, arising from various anatomical anomalies such as posterior urethral valves (PUV), urethral atresia, and cloacal malformations, disrupts normal urine flow, resulting in secondary complications such as pulmonary hypoplasia and renal impairment. Current management strategies, including fetal vesicoamniotic shunting (VAS) and fetal cystoscopy, aim to alleviate obstruction and mitigate associated risks. While VAS has been a longstanding intervention, fetal cystoscopy presents a promising alternative by enabling direct visualization and targeted treatment of urinary tract obstructions. However, fetal cystoscopy is not without challenges, including technical complexities and risks associated with invasive procedures. This review explores the rationale, indications, technical considerations, outcomes, and future innovations of fetal cystoscopy in managing LUTO. It highlights the critical role of accurate diagnosis, patient selection, and procedural expertise in optimizing fetal and maternal outcomes. Despite existing challenges, ongoing advancements in technology and clinical practice hold the potential for further enhancing the safety and efficacy of fetal cystoscopy, underscoring its evolving role in prenatal care.
胎儿下尿路梗阻（LUTO）包括一系列影响胎儿泌尿系统的罕见先天性异常，会导致严重的发病率和死亡率。这种情况由各种解剖学异常引起，如后尿道瓣膜（PUV）、尿道闭锁和泄殖腔畸形，会扰乱正常尿液流动，导致诸如肺发育不全和肾功能损害等继发性并发症。目前的治疗策略，包括胎儿膀胱羊膜分流术（VAS）和胎儿膀胱镜检查，旨在缓解梗阻并降低相关风险。虽然VAS一直是一种长期的干预措施，但胎儿膀胱镜检查通过能够直接观察和针对性治疗尿路梗阻，提供了一种有前景的替代方法。然而，胎儿膀胱镜检查并非没有挑战，包括技术复杂性和与侵入性手术相关的风险。本综述探讨了胎儿膀胱镜检查在管理LUTO中的基本原理、适应症、技术考虑因素、结果和未来创新。它强调了准确诊断、患者选择和手术专业知识在优化胎儿和产妇结局方面的关键作用。尽管存在现有挑战，但技术和临床实践的持续进步有可能进一步提高胎儿膀胱镜检查的安全性和有效性，凸显了其在产前护理中不断演变的作用。
