ntrauterin tan› alan posterior üretral valv olgusunda fetoskopik lazer valv ablasyonu

Fetoscopic laser valve ablation in the posterior urethral valve case with intrauterine diagnosis

Özet

Amaç: Alt üriner sistem obstrüksiyonu tan›s› alan bir fetüse uygulanan intrauterin perkütan fetoskopik lazer valv ablasyonu ifllemini sunmay› amaçlad›k. Olgu: Yirmi bir yafl›nda, düzenli takipleri olmayan gebenin fetal ultrasonografik de¤erlendirilmesinde bilateral hidroüreteronefroz, dilate mesane, oligo/anhidramniyoz saptand› ve olguda posterior üretral valv ile uyumlu alt üriner sistem obstrüksiyonu düflünüldü. Ard›fl›k uygulanan vezikosentez sonucu kötü prognozlu saptanan hastaya, takip ve tedavi seçenekleri hakk›nda bilgi verildi ve 27. gebelik haftas›nda perkütan fetoskopik lazer ile posterior üretral valv ablasyonu yap›ld›. ‹fllem sonras› amniyon s›v›s› normal s›n›rda seyretti ve miad›nda do¤um gerçekleflti. Postpartum kreatinin yüksekli¤ i olan yenido¤ana evre 2 böbrek yetmezli¤i tan›s› konuldu ve takiplerinde diyaliz ihtiyac› olmad›. Kreatinin de¤erleri gerileyen yenido¤an ayaktan takip edilmek üzere taburcu edildi. Sonuç: Alt üriner sistem obstrüksiyonu varl›¤›nda intrauterin müdahalenin sa¤kal›m› art›r›c› etkisi dikkate al›narak gebeli¤in devam› n› isteyen olgularda seçenek olabilece¤i olabilece¤ini düflünüyoruz. Aile obstrüksiyonun düzeltilmesine yönelik intrauterin müdahalenin fayda ve riskleri hakk›nda ayr›nt›l› bilgilendirilmelidir.

Abstract

Objective: We aimed to present the procedure of intrauterine percutaneous fetoscopic laser valve ablation performed on a fetus diagnosed with lower urinary tract obstruction. Case: Bilateral hydroureteronephrosis, dilated bladder and oligo/ anhydramnios were found in the fetal ultrasonography examination of a 21-year-old pregnant woman who did not have regular followups, and the lower urinary tract obstruction consistent with the posterior urethral valve was considered in the case. The patient who was found to have poor prognosis as a result of vesico synthesis carried out consecutively was informed about the follow-up and treatment options, and the posterior urethral valve ablation was performed by the percutaneous fetoscopic laser on 27 weeks of gestation. The amniotic fluid was at normal levels after the procedure, and the labor was carried out at term. The newborn with elevated postpartum creatinine was diagnosed with stage 2 renal failure, but dialysis was not required during the follow-ups. The newborn was discharged for outpatient follow-up upon the reduced creatinine levels. Conclusion: By taking the survival enhancing effect of the intrauterine intervention into account in the presence of lower urinary tract obstruction, we considered that intrauterine intervention can be an option in the cases who prefer to continue their pregnancies. The families should be informed in detail about the benefits and risks of intrauterine intervention to repair the obstruction.