IN-UTERO ENDOSCOPIC TREATMENT OF POSTERIOR URETHRAL VALVES - PRELIMINARY EXPERIENCE

cystoscopy was performed in nine fetuses with sonographic evidence of lower urinary tract obstruction and normal urinary electrolytes, Poste rior urethral valves (PUV) were thought to be present in all cases. En doscopic fulguration of the valves was performed with YAG-laser energy or electrosurgery using an operating 2.4-mm endoscope, Urethral paten cy was documented with vesicoinfusion and color Doppler by noting pass age of fluid from the fetal bladder into the amniotic cavity. A vesico amniotic shunt was not typically placed at this setting. Three of nine cases did not have PUV: one fetus had urethral atresia, another had a mbiguous genitalia and the third had anal atresia, rectovesical fistul a and anterior obstruction. Six of nine cases were confirmed postnatal ly to have had PUV and urethral patency was documented in four of thes e six cases (66%). The amniotic fluid volume recovered spontaneously i n three of these four cases and was maintained postoperatively. The ur ethra was not clinically patent in the remaining two cases, but. patho logical confirmation could not be obtained. Three of nine fetuses surv ived the neonatal period: two with PUV and the one with urethral atres ia. All three babies died of unrelated complications. Two of nine fetu ses had failed a pre-cystoscopy shunt. A post-cystoscopy shunt also fa iled in an additional fetus. While there are no long term survivors in this series, our early experience shows that urethral patency can he achieved in utero with preservation of renal function and pulmonary de velopment. Further experience is required to improve the diagnosis of PUV and to develop a better technique for eliminating the obstruction.