In utero endoscopic treatment of posterior urethral valves: Preliminary experience

Abstract

Fetal cystoscopy was performed in nine fetuses with sonographic evidence of lower urinary tract obstruction and normal urinary electrolytes. Posterior urethral valves (PUV) were thought to be present in all cases. Endoscopic fulguration of the valves was performed with YAG-laser energy or electrosurgery using an operating 2.4-mm endoscope. Urethral patency was documented with vesicoinfusion and color Doppler by noting passage of fluid from the fetal bladder into the amniotic cavity. A vesicoamniotic shunt was not typically placed at this setting. Three of nine cases did not have PUV: one fetus had urethral atresia, another had ambiguous genitalia and the third had anal atresia, rectovesical fistula and anterior obstruction. Six of nine cases were confirmed postnatally to have had PUV and urethral patency was documented in four of these six cases (66%). The amniotic fluid volume recovered spontaneously in three of these four cases and was maintained postoperatively. The urethra was not