■产前巨囊肿的诊断对妊娠有重大影响,因为它会对胎儿和新生儿的存活以及肾脏和肺功能产生严重的不良影响。该研究旨在调查胎儿巨细胞的自然史,试图区分子宫内先天性下尿路梗阻(LUTO)与非阻塞性巨膀胱,and,可能,预测产后结局。
■2015年7月至2023年11月进行了回顾性单中心观察性研究。纳入标准为妊娠早期膀胱纵向直径(LBD)>7mm,或妊娠中期和晚期膀胱过度扩张/增厚。密切超声随访,多学科产前咨询,并提供侵入性和非侵入性基因测试。在终止妊娠或宫内胎儿死亡(IUFD)的情况下,获得了胎儿尸检的知情同意书。出生后,在同一中心对新生儿进行了随访。患者根据诊断进行分层:LUTO(G1),除LUTO外的泌尿生殖系统异常(“非LUTO”)(G2),和正常泌尿道(G3)。
■这项研究包括27个胎儿,其中26人为男性。在92%的胎儿中,在第二和第三个三个月中被诊断出Megacystis。在27个胎儿中,3人(11.1%)进行了流产,1人患有IUFD。23例新生儿为活产(85%),平均胎龄(GA)为34±2周。两名患者(新生儿)由于严重的相关畸形而在出生后死亡。评估了几种产前参数,以区分LUTO患者和非LUTO患者,包括上尿道扩张的严重程度,钥匙孔标志,羊水过少,LBD,和GA在诊断。然而,没有证明可以预测产后诊断。同样,所评估的产前参数均不能预测出生后的肾功能.
在妊娠中期和晚期诊断为巨大孢子的病例中,高达85%的病例与活产有关,与LUTO确定为胎儿巨囊肿的主要原因。这个潜在的更有利的结果,与文献中报道的大多数相比,产前咨询应考虑在内。Megacystis是一种经常被误解的触角体征,可能会掩盖各种预后不同的诊断,除了增加不良肾脏和呼吸道结局的风险。
UNASSIGNED: Diagnosis of prenatal megacystis has a significant impact on the pregnancy, as it can have severe adverse effects on fetal and neonatal survival and renal and pulmonary function. The study aims to investigate the natural history of fetal megacystis, to try to differentiate in utero congenital lower urinary tract obstruction (LUTO) from non-obstructive megacystis, and, possibly, to predict postnatal outcome.
UNASSIGNED: A retrospective single-center observational study was conducted from July 2015 to November 2023. The inclusion criteria were a longitudinal bladder diameter (LBD) >7 mm in the first trimester or an overdistended/thickened-walled bladder failing to empty in the second and third trimesters. Close ultrasound follow-up, multidisciplinary prenatal counseling, and invasive and non-invasive genetic tests were offered. Informed consent for fetal autopsy was obtained in cases of termination of pregnancy or intrauterine fetal demise (IUFD). Following birth, neonates were followed up at the same center. Patients were stratified based on diagnosis: LUTO (G1), urogenital anomalies other than LUTO (\"non-LUTO\") (G2), and normal urinary tract (G3).
UNASSIGNED: This study included 27 fetuses, of whom 26 were males. Megacystis was diagnosed during the second and third trimesters in 92% of the fetuses. Of the 27 fetuses, 3 (11.1%) underwent an abortion, and 1 had IUFD. Twenty-three newborns were live births (85%) at a mean gestational age (GA) of 34 ± 2 weeks. Two patients (neonates) died postnatally due to severe associated malformations. Several prenatal parameters were evaluated to differentiate patients with LUTO from those with non-LUTO, including the severity of upper tract dilatation, keyhole sign, oligohydramnios, LBD, and GA at diagnosis. However, none proved predictive of the postnatal diagnosis. Similarly, none of the prenatal parameters evaluated were predictive of postnatal renal function.
UNASSIGNED: The diagnosis of megacystis in the second and third trimesters was associated with live births in up to 85% of cases, with LUTO identified as the main cause of fetal megacystis. This potentially more favorable outcome, compared to the majority reported in literature, should be taken into account in prenatal counseling. Megacystis is an often misinterpreted antennal sign that may hide a wide range of diagnoses with different prognoses, beyond an increased risk of adverse renal and respiratory outcomes.