66 timestamped statements
across 2 collections
— auto-found in recorded discussions, each timestamp jumps to the exact moment.
Featured statements
▶Ep 6 · 2:35
We need to base our evaluation on the bladder tap using the fetal urine analysis, using the ultrasound to recognize the quality of the renal parenchyma and there is cystic dysplasia or not, and most importantly, In my opinion, the bladder refilling after the bladder tap.
We need to base our evaluation on the bladder tap using the fetal urine analysis, using the ultrasound to recognize the quality of the renal parenchyma and there is cystic dysplasia or not, and most importantly, In my opinion, the bladder refilling after the bladder tap.
Basically, the problem we have with fetal cystoscopy to attempt these posteriurethral valves is the angulation we have. We can access very well the bladder, but sometimes it's very difficult to see well, the orientation in the posteriral valves during the surgery.
Basically, the problem we have with fetal cystoscopy to attempt these posteriurethral valves is the angulation we have. We can access very well the bladder, but sometimes it's very difficult to see well, the orientation in the posteriral valves during the surgery.
Prenatal intervention for Fetal Urinary Tract Obstruction
▶Ep 6 · 0:19
quoteThe first thing is that to offer any fetal therapy, we need to make a good diagnosis.↗
▶Ep 6 · 0:19
clinicalPrenatal diagnosis of fetal urinary tract obstruction requires ultrasound assessment of keyhole sign, bladder thickness, amniotic fluid volume, and fetal sex.↗
▶Ep 6 · 0:51
clinicalIn male fetuses, posterior urethral valves can be diagnosed and are amenable to fetal intervention.↗
▶Ep 6 · 0:51
quoteIf it's a male and potential posterior urethral valves.↗
▶Ep 6 · 1:12
clinicalFetal urinary tract obstruction causes pulmonary hypoplasia due to anhydramnios (insufficient amniotic fluid leading to underdeveloped lungs).↗
▶Ep 6 · 1:12
clinicalObstructive nephropathy from urinary tract obstruction creates renal dysplasia, leading to renal insufficiency with associated morbidity, mortality, and need for transplant.↗
▶Ep 6 · 1:12
clinicalA distended bladder without cycling contractions produces bladder dysfunction with infections and other problems postnatally.↗
▶Ep 6 · 1:12
quoteWe have pulmonary hypoplasia because insufficient lungs as a result of the anidramius, renal insufficiency in many cases because this obstructive neuropathy creating renal dysplasia.↗
▶Ep 6 · 2:02
clinicalTherapeutic goals for fetal urinary tract obstruction are to restore amniotic fluid (protect lungs), decompress the urinary system (protect kidneys), and allow detrusor cycling (protect bladder function).↗
▶Ep 6 · 2:02
quoteTo treat the lungs, we will need to restore the amniotic fluid around the baby to enhance normal lung development.↗
▶Ep 6 · 2:35
clinicalRenal function assessment in fetal urinary obstruction is based on bladder tap (fetal urine analysis), ultrasound evaluation of renal parenchyma for cystic dysplasia, and bladder refilling after bladder tap.↗
▶Ep 6 · 2:35
quoteWe need to base our evaluation on the bladder tap using the fetal urine analysis, using the ultrasound to recognize the quality of the renal parenchyma and there is cystic dysplasia or not, and most importantly, In my opinion, the bladder refilling after the bladder tap.↗
▶Ep 6 · 3:06
quoteOne side benefit of the bladder tap is if you actually aspirate out the urine and you see the bladder refill with urine again, you now know that the fetus has the ability to make urine.↗
▶Ep 6 · 3:06
clinicalBladder refilling after vesicocentesis demonstrates that the fetus has the ability to make urine.↗
▶Ep 6 · 3:29
quoteWe actually can see severe renal dysplasia where the baby makes no urine at all. We have no option to improve these kidneys at all. The only goal of the treatment will be a pulmonary survivor, to save the land by replacing the amniotic fluid also.↗
▶Ep 6 · 3:29
clinicalIn cases with no renal dysplasia where kidneys make plenty of urine, decompressive techniques can theoretically rescue both kidney and lung function.↗
▶Ep 6 · 3:29
clinicalIn moderate or borderline renal dysplasia where kidneys make small amounts of urine, intervention is likely too late to save kidney function but can save the lungs and provide the option of renal transplant.↗
▶Ep 6 · 3:29
clinicalIn severe renal dysplasia where the fetus makes no urine, the only treatment goal is pulmonary survival by replacing amniotic fluid; kidney function cannot be improved.↗
▶Ep 6 · 5:04
clinicalVesico-amniotic shunt devices commonly used include Rodeck, Harrison, Cook, and Summaex (more common in Europe).↗
▶Ep 6 · 5:17
epidemiologicalOverall survival with vesico-amniotic shunting is approximately 50%, and of survivors, 40% will develop end-stage renal disease.↗
▶Ep 6 · 5:17
host_summaryComplications of vesico-amniotic shunting include blockage, shunt migration (common as fetuses pull or dislodge the shunt), preterm delivery, urinary ascites, chorioamnionitis, iatrogenic gastroschisis, and abdominal or inguinal herniation.↗
▶Ep 6 · 5:17
epidemiologicalVesico-amniotic shunt placement has a 98% technical success rate but a 15% complication rate, with complications carrying 100% mortality due to loss of amniotic fluid.↗
▶Ep 6 · 7:15
clinicalOpen fetal surgery for vesicostomy was attempted by Crombleholme and Lim in Cincinnati, using minimal uterine exposure to create an abdominal wall opening and marsupialize the bladder for drainage, allowing spontaneous postnatal closure.↗
▶Ep 6 · 8:14
epidemiologicalIn the Cincinnati Children's Hospital series, 6 male fetuses between 19-22 weeks gestational age with anhydramnios and normal fetal urine electrolytes underwent open vesicostomy; all achieved complete postnatal urinary tract decompression, but only 2 of 6 survived, with no maternal complications.↗
▶Ep 6 · 9:06
quoteBasically, the problem we have with fetal cystoscopy to attempt these posteriurethral valves is the angulation we have. We can access very well the bladder, but sometimes it's very difficult to see well, the orientation in the posteriral valves during the surgery.↗
▶Ep 6 · 9:06
clinicalThe main technical challenge with fetal cystoscopy for posterior urethral valves is the angulation; while bladder access is good, visualization and orientation of the posterior urethral valves during surgery can be difficult.↗
▶Ep 6 · 10:08
clinicalTransurethral catheter placement can be combined with laser therapy for posterior urethral valve treatment; in one case at 23 weeks, a wire was used to identify and access valves, followed by laser ablation and transurethral catheter deployment.↗
▶Ep 6 · 10:08
host_summaryA study by Ruano et al. found 60% survival with therapeutic fetal cystoscopy compared to 10% in the control group.↗
▶Ep 6 · 10:40
host_summaryA 2015 study by Ruano et al. comparing fetal cystoscopy, VA shunting, and no intervention found survival rates of 66%, 60%, and 17% respectively.↗
▶Ep 6 · 10:40
host_summaryThe 2015 Ruano study suggested fetal cystoscopy decreased the incidence of chronic kidney disease in patients with posterior urethral valves.↗
▶Ep 6 · 12:05
clinicalMethods for amniotic fluid restoration include repeated serial amnio-infusions with needle (once weekly initially, twice weekly in late gestation) or placement of an amnio-port.↗
▶Ep 6 · 12:05
clinicalAmnio-port is a metal port used for intravascular medication and parenteral nutrition that can be implanted inside the uterus for easy subcutaneous access to replace amniotic fluid.↗
▶Ep 6 · 12:05
clinicalFor fetuses with kidney dysplasia and minimal urine output who are not candidates for shunt or cystoscopy, the only option is attempting lung rescue by placing fluid from outside to restore amniotic fluid.↗
Prenatal intervention for Fetal Urinary Tract Obstruction
▶Ep 6 · 0:19
clinicalPrenatal diagnosis of fetal urinary tract obstruction requires ultrasound assessment of keyhole sign, bladder thickness, amniotic fluid volume, and fetal sex.↗
▶Ep 6 · 0:19
quoteThe first thing is that to offer any fetal therapy, we need to make a good diagnosis.↗
▶Ep 6 · 0:51
clinicalIn male fetuses, posterior urethral valves can be diagnosed and are amenable to fetal intervention.↗
▶Ep 6 · 0:51
quoteIf it's a male and potential posterior urethral valves.↗
▶Ep 6 · 1:12
clinicalObstructive nephropathy from urinary tract obstruction creates renal dysplasia, leading to renal insufficiency with associated morbidity, mortality, and need for transplant.↗
▶Ep 6 · 1:12
clinicalFetal urinary tract obstruction causes pulmonary hypoplasia due to anhydramnios (insufficient amniotic fluid leading to underdeveloped lungs).↗
▶Ep 6 · 1:12
quoteWe have pulmonary hypoplasia because insufficient lungs as a result of the anidramius, renal insufficiency in many cases because this obstructive neuropathy creating renal dysplasia.↗
▶Ep 6 · 1:12
clinicalA distended bladder without cycling contractions produces bladder dysfunction with infections and other problems postnatally.↗
▶Ep 6 · 2:02
quoteTo treat the lungs, we will need to restore the amniotic fluid around the baby to enhance normal lung development.↗
▶Ep 6 · 2:02
clinicalTherapeutic goals for fetal urinary tract obstruction are to restore amniotic fluid (protect lungs), decompress the urinary system (protect kidneys), and allow detrusor cycling (protect bladder function).↗
▶Ep 6 · 2:35
clinicalRenal function assessment in fetal urinary obstruction is based on bladder tap (fetal urine analysis), ultrasound evaluation of renal parenchyma for cystic dysplasia, and bladder refilling after bladder tap.↗
▶Ep 6 · 2:35
quoteWe need to base our evaluation on the bladder tap using the fetal urine analysis, using the ultrasound to recognize the quality of the renal parenchyma and there is cystic dysplasia or not, and most importantly, In my opinion, the bladder refilling after the bladder tap.↗
▶Ep 6 · 3:06
clinicalBladder refilling after vesicocentesis demonstrates that the fetus has the ability to make urine.↗
▶Ep 6 · 3:06
quoteOne side benefit of the bladder tap is if you actually aspirate out the urine and you see the bladder refill with urine again, you now know that the fetus has the ability to make urine.↗
▶Ep 6 · 3:29
clinicalIn severe renal dysplasia where the fetus makes no urine, the only treatment goal is pulmonary survival by replacing amniotic fluid; kidney function cannot be improved.↗
▶Ep 6 · 3:29
quoteWe actually can see severe renal dysplasia where the baby makes no urine at all. We have no option to improve these kidneys at all. The only goal of the treatment will be a pulmonary survivor, to save the land by replacing the amniotic fluid also.↗
▶Ep 6 · 3:29
clinicalIn cases with no renal dysplasia where kidneys make plenty of urine, decompressive techniques can theoretically rescue both kidney and lung function.↗
▶Ep 6 · 3:29
clinicalIn moderate or borderline renal dysplasia where kidneys make small amounts of urine, intervention is likely too late to save kidney function but can save the lungs and provide the option of renal transplant.↗
▶Ep 6 · 5:04
clinicalVesico-amniotic shunt devices commonly used include Rodeck, Harrison, Cook, and Summaex (more common in Europe).↗
▶Ep 6 · 5:17
epidemiologicalVesico-amniotic shunt placement has a 98% technical success rate but a 15% complication rate, with complications carrying 100% mortality due to loss of amniotic fluid.↗
▶Ep 6 · 5:17
epidemiologicalOverall survival with vesico-amniotic shunting is approximately 50%, and of survivors, 40% will develop end-stage renal disease.↗
▶Ep 6 · 5:17
host_summaryComplications of vesico-amniotic shunting include blockage, shunt migration (common as fetuses pull or dislodge the shunt), preterm delivery, urinary ascites, chorioamnionitis, iatrogenic gastroschisis, and abdominal or inguinal herniation.↗
▶Ep 6 · 7:15
clinicalOpen fetal surgery for vesicostomy was attempted by Crombleholme and Lim in Cincinnati, using minimal uterine exposure to create an abdominal wall opening and marsupialize the bladder for drainage, allowing spontaneous postnatal closure.↗
▶Ep 6 · 8:14
epidemiologicalIn the Cincinnati Children's Hospital series, 6 male fetuses between 19-22 weeks gestational age with anhydramnios and normal fetal urine electrolytes underwent open vesicostomy; all achieved complete postnatal urinary tract decompression, but only 2 of 6 survived, with no maternal complications.↗
▶Ep 6 · 9:06
clinicalThe main technical challenge with fetal cystoscopy for posterior urethral valves is the angulation; while bladder access is good, visualization and orientation of the posterior urethral valves during surgery can be difficult.↗
▶Ep 6 · 9:06
quoteBasically, the problem we have with fetal cystoscopy to attempt these posteriurethral valves is the angulation we have. We can access very well the bladder, but sometimes it's very difficult to see well, the orientation in the posteriral valves during the surgery.↗
▶Ep 6 · 10:08
host_summaryA study by Ruano et al. found 60% survival with therapeutic fetal cystoscopy compared to 10% in the control group.↗
▶Ep 6 · 10:08
clinicalTransurethral catheter placement can be combined with laser therapy for posterior urethral valve treatment; in one case at 23 weeks, a wire was used to identify and access valves, followed by laser ablation and transurethral catheter deployment.↗
▶Ep 6 · 10:40
host_summaryA 2015 study by Ruano et al. comparing fetal cystoscopy, VA shunting, and no intervention found survival rates of 66%, 60%, and 17% respectively.↗
▶Ep 6 · 10:40
host_summaryThe 2015 Ruano study suggested fetal cystoscopy decreased the incidence of chronic kidney disease in patients with posterior urethral valves.↗
▶Ep 6 · 12:05
clinicalFor fetuses with kidney dysplasia and minimal urine output who are not candidates for shunt or cystoscopy, the only option is attempting lung rescue by placing fluid from outside to restore amniotic fluid.↗
▶Ep 6 · 12:05
clinicalMethods for amniotic fluid restoration include repeated serial amnio-infusions with needle (once weekly initially, twice weekly in late gestation) or placement of an amnio-port.↗
▶Ep 6 · 12:05
clinicalAmnio-port is a metal port used for intravascular medication and parenteral nutrition that can be implanted inside the uterus for easy subcutaneous access to replace amniotic fluid.↗
