SEVERE URETHRAL OBSTRUCTION DIAGNOSED AT 14 WEEKS GESTATION - VARIABILITY OF OUTCOME WITH AND WITHOUT DRAINAGE

We present 3 case reports to illustrate the variability of outcome of severe fetal posterior urethral obstruction. Two of the described case s support the view that early in-utero decompression of an obstructed fetal urinary system into the amniotic cavity, in the selected patient , will allow adequate lung development and will prevent the developmen t of severe renal dysplasia. It will not prevent the abdominal wall de formity of the prune belly syndrome. The evidence suggests that to all ow maximum time for lung development and to prevent increasing renal d ysplasia, drainage should be performed before 18 weeks of gestation. T o obtain maximum effect, this drainage should continue until at least 32-33 weeks' gestation, so that the possible respiratory problems of p rematurity would not be severe enough to compound the degree of lung h ypoplasia which might be present. Case 3 supports our view that an end oscopic approach to in-utero drainage of the urinary tract has the adv antage of achieving drainage with minimal risk to both mother and fetu s.