Journal Mobile Options
Table of Contents
Vol. 23, No. 2, 2008
Issue release date: March 2008
Fetal Diagn Ther 2008;23:81–86

Fetoscopic Transuterine Release of Posterior Urethral Valves: A New Technique

Clifton M.S. · Harrison M.R. · Ball R. · Lee H.
Fetal Treatment Center, University of California, San Francisco, San Francisco, Calif., USA

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Fetal urinary tract obstruction with oligohydramnios produces pulmonary hypoplasia and renal dysplasia. Decompression of the obstructed urinary tract may restore amniotic fluid and allow lung growth, but transabdominal catheter shunt decompression is often inadequate and does not allow for cycling of the bladder, while open procedures cause significant maternal morbidity. Disruption of the anatomic obstruction, usually posterior urethral valves in a male fetus, would be ideal but has proven technically difficult. Here we describe a new technique of percutaneous fetal cystoscopy and disruption of posterior urethral valves, and the case report of our first application of this technique. We pre-sent a case of a 17-week male fetus with posterior urethral valves which underwent fetal cystoscopy for mechanical disruption of posterior urethral valves. This minimally invasive approach to disruption of posterior urethral valves in a fetus is a novel method for decompressing the urinary tract. The technique offers a minimal degree of maternal morbidity and, if instituted early enough, can restore amniotic fluid volume, avert fatal pulmonary hypoplasia and may preserve renal function.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Harrison MR, Filly RA, Parer JT, Faer MJ, Jacobson, JB, de Lorimier AA: Management of the fetus with a urinary tract malformation. JAMA 1981;246:635–639.
  2. Harrison MR, Nakayama DK, Noall R, de Lorimier AA: Correction of congenital hydronephrosis in utero. II. Decompression reverses the effects of obstruction on the fetal lung and urinary tract. J Pediatr Surg 1982;17:965–974.
  3. Glick PL, Harrison MR, Adzick NS, Noall RA, Villa RL: Correction of congenital hydronephrosis in utero. IV. In utero decompression prevents renal dysplasia. J Pediatr Surg 1984;19:649–657.
  4. Crombleholme TM, Harrison MR, Longaker MT, Langer JC: Prenatal diagnosis and management of bilateral hydronephrosis. Pediatr Nephrol 1988;2:334–342.
  5. Crombleholme TM, Harrison MR, Golbus MS, Longaker MT, Langer, JC, Callen PW, Anderson RL, Goldstein RB, Filly RA: Fetal intervention in obstructive uropathy: prognostic indicators and efficacy of intervention. Am J Obstet Gynecol 1990;162:1239–1244.
  6. Nicolini U, Vaughan JI, Fisk NM, Dhillon HK, Rodeck CH: Cystic lesions of the fetal kidney: diagnosis and prediction of postnatal function by fetal urine biochemistry. J Pediatr Surg 1992;27:1451–1454.
  7. Nicolini U, Fisk NM, Rodeck CH, Beacham J: Fetal urine biochemistry: an index of renal maturation and dysfunction. Br J Obstet Gynaecol 1992;99:46–50.
  8. Crombleholme TM, Harrison MR, Langer JC, Longaker MT, Anderson RL, Slotnick NS, Filly RA, Callen PW, Goldstein RB, Golbus MS: Early experience with open fetal surgery for congenital hydronephrosis. J Pediatr Surg 1988;23:1114–1121.
  9. Freedman AL, Johnson MP, Smith CA, Gonzalez R, Evans MI: Long-term outcome in children after antenatal intervention for obstructive uropathies. Lancet 1999;354:374–377.
  10. Holmes N, Harrison MR, Baskin LS: Fetal surgery for posterior urethral valves: long-term postnatal outcomes. Pediatrics 2001;108:E7.
  11. Harrison MR, Golbus MS, Filly RA, Anderson RL, Flake AW, Rosen M, Huff RW: Fetal hydronephrosis: selection and surgical repair. J Pediatr Surg 1987;22:556–558.
  12. Estes JM, MacGillivray TE, Hedrick MH, Adzick NS, Harrison MR: Fetoscopic surgery for the treatment of congenital anomalies. J Pediatr Surg 1992;27:950–954.
  13. Feitz WF, Steegers EA, Aarnink RG, Arts T, De Vries JD, Van der Wildt B: Endoscopic intrauterine fetal therapy: a monkey model. Urology 1996;47:118–119.
  14. Oberg KC, Robles AE, Ducsay CA, Rasi CR, Rouse GA, Childers BJ, Evans ML, Kirsch WM, Hardesty RA: Endoscopic intrauterine surgery in primates: overcoming technical obstacles. Surg Endosc 1999;13:420–426.
  15. Luks FI, Deprest J, Marcus M, Vandenberghe K, Vertommen JD, Lerut T, Brosens I: Carbon dioxide pneumoamnios causes acidosis in fetal lamb. Fetal Diagn Ther 1994;9:105–109.
  16. Sato Y, Kitagawa H, Pringle KC, Koike J, Zuccollo J, Robinson R, Wakisaka M, Seki Y, Nakada K: Effects of early vesicostomy in obstructive uropathy on bladder development. J Pediatr Surg 2004;39:1849–1852.
  17. Kitagawa H, Pringle KC, Koike J, Zuccollo J, Seki Y, Wakisaka M, Sato Y, Sato H, Nagae H, Nakada K: Vesicoamniotic shunt for complete urinary tract obstruction is partially effective. J Pediatr Surg 2006;41:394–402.
  18. Workman SJ, Kogan BA: Fetal bladder histology in posterior urethral valves and the prune belly syndrome. J Urol 1990;144:337–339.
  19. Kim KM, Kogan BA, Massad CA, Huang YC: Collagen and elastin in the obstructed fetal bladder. J Urol 1991;146:528–531.
  20. Irwin BH, Vane DW: Successful in utero endoscopic ablation of posterior urethral valves: a new dimension in fetal urology. Urology 2000;55:774.
  21. Gehring JE, Cain MP, Casale AJ, Kaefer M, Rink RC: Abdominal wall hernia: an uncommon complication of in utero vesicoamniotic shunt placement. Urology 2000;56:330.
  22. Farmer DL: Fetal surgery: a brief review. Pediatr Radiol 1998;28:409–413.
  23. Kohl T, Szabo Z, Suda K, Quinn TM, Petrossian E, Harrison MR, Hanley FL: Percutaneous fetal access and uterine closure for fetoscopic surgery: lessons learned from 16 consecutive procedures in pregnant sheep. Surg Endosc 1997;11:819–824.
  24. Feldstein VA, Machin GA, Albanese CT, Sandberg P, Farrell JA, Farmer DL, Harrison MR: Twin-twin transfusion syndrome: the ‘Select’ procedure. Fetal Diagn Ther 2000;15:257–261.
  25. Fowler SF, Sydorak RM, Albanese CT, Far-mer DL, Harrison MR, Lee H: Fetal endoscopic surgery: lessons learned and trends reviewed. J Pediatr Surg 2002;37:1700–1702.
  26. Tsao K, Feldstein VA, Albanese CT, Sandberg PL, Lee H, Harrison MR, Farmer DL: Selective reduction of acardiac twin by radiofrequency ablation. Am J Obstet Gynecol 2002;187:635–640.
  27. Bruner JP, Jarnagin BK, Reinisch L: Percutaneous laser ablation of fetal congenital cystic adenomatoid malformation: too little, too late? Fetal Diagn Ther 2000;15:359–363.
  28. Quintero RA, Hume R, Smith C, Johnson MP, Cotton DB, Romero R, Evans MI: Percutaneous fetal cystoscopy and endoscopic fulguration of posterior urethral valves. Am J Obstet Gynecol 1995;172:206–209.
  29. Quintero RA, Johnson MP, Romero R, Smith C, Arias F, Guevara-Zuloaga F, Cotton DB, Evans MI: In-utero percutaneous cystoscopy in the management of fetal lower obstructive uropathy. Lancet 1995;346:537–540.
  30. Glick PL, Harrison MR, Golbus MS, Adzick NS, Filly RA, Callen PW, Mahony BS, Anderson RL, deLorimier AA: Management of the fetus with congenital hydronephrosis. II. Prognostic criteria and selection for treatment. J Pediatr Surg 1985;20:376–387.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50