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Antenatal diagnosis and management of fetal megacystis and lower urinary tract obstruction

PhD ceremony:Ms F. (Federica) Fontanella
When:January 09, 2019
Start:14:30
Supervisors:prof. dr. C.M. (Katia) Bilardo, prof. dr. D. Oepkes
Where:Academy building RUG
Faculty:Medical Sciences / UMCG
Antenatal diagnosis and management of fetal megacystis and lower
urinary tract obstruction

Antenatal diagnosis and management of fetal megacystis and lower urinary tract obstruction

The term LUTO refers to a heterogeneous group of anatomical anomalies characterized by an obstruction in the urethra and by an increased intraluminal pressure along the urinary tract. During fetal life, LUTO leads to the development of an enlarged urinary bladder (also known as megacystis), severe hydronephrosis and oligohydramnios with high risk of early renal damage and perinatal mortality. Over the last 20 years, fetal therapy, in the form of vesico-amniotic shunt or fetal cystoscopy, has been attempted on the assumption that by relieving the intrauterine pressure caused by the obstruction, mortality and renal damage could be possible prevented. However, to date, whether and when the in-utero treatment should be offered is still a matter of debate, and the eventual selection of candidates remains suboptimal owing to the disappointing diagnostic accuracy of fetal LUTO.Aim of this thesis was to gather clinical data at a national level in order to elucidate the natural history of fetal megacystis and to guide fetal specialists in the challenging counseling, diagnostic work-up and antenatal management from fetal megacystis to LUTO.