OUTCOME OF ANTENATAL INTERVENTION FOR POSTERIOR URETHRAL VALVE

CLINICAL CASE

Abstract

Posterior Urethral Valves (PUV) are the most common cause of lower urinary tract obstruction in male fetuses, eventually leading to compromised kidney function as well as pulmonary hypoplasia due to oligohydramnios.A 34-year-old primigravida nullipara in her 18th gestational week was referred to the Elias Emergency University Hospital in Bucharest for further second trimester morphology investigations. The prenatal course was uncomplicated prior to admission. The ultrasound examination revealed fetal megacystis, severe oligohydramnios and a dilated urethra giving the appearance of the “keyhole” sign. These findings were consistent with the diagnosis of posterior urethral valves. In an attempt to temporize the unfavorable evolution, our patient decided to undergo a percutaneous vesicoamniotic shunting in order to bypass the obstructed urethra through a pig-tailed catheter placed between the fetal bladder and the amniotic cavity. Although the procedure has improved the ultrasonographic appearance of the fetal kidneys and the existing oligohydramnios was corrected, the long term evolution was eventually poor because of the previously compromised renal function.