In utero treatment for bladder outlet obstruction using robot assisted laparoscopic techniques

The Journal of Urology
Carlo C PasserottiHiep T Nguyen

Abstract

Bladder outlet obstruction can have devastating consequences. Given the poor outcome, intervention in utero has been advocated in an attempt to salvage pulmonary and renal function. We evaluated whether laparoscopic decompression of the obstructed bladder could be performed efficiently by adapting current robot assisted laparoscopic techniques to access the fetus in utero. At 95 days of gestation 20 fetal sheep underwent ligation of the urethra and urachus. Two to 5 days later robot assisted laparoscopic vesicostomy was performed. Ultrasound of the kidneys and bladder was performed before each procedure. At 135 days of gestation the urinary tract was evaluated to assess the adequacy of bladder decompression and a patent vesicostomy. After 48 hours of undergoing ligation all fetuses had bilateral moderate hydronephrosis and a markedly distended bladder. In the first 10 fetuses vesicostomy could not be completed laparoscopically due to limited visualization. Additional modifications in trocar placement and gas infusion allowed vesicostomy to be completed laparoscopically in the last 8 fetuses in 2.5 to 4 hours. Urinary tract decompression and a patent vesicostomy were observed in all of these fetuses postoperatively. We developed...Continue Reading

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Citations

Oct 7, 2015·Journal of Pediatric Urology·L I Smith-HarrisonSean T Corbett
Dec 17, 2008·BJOG : an International Journal of Obstetrics and Gynaecology·P KlaritschJ Deprest
Jun 2, 2016·Prenatal Diagnosis·Michael P KurtzRodrigo Ruano

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