Внутриутробная хирургическая коррекция урином у плодов: анализ исходов
DOI: 10.32364/2618-8430-2024-7-2-3
N.V. Kosovtsova, N.A. Fedorova, Ya.Yu. Pospelova
Research Institute of Maternity and Infancy Protection, Ekaterinburg, Russian Federation
Aim: to analyze the outcomes of intrauterine fetal surgery of urinoma and discuss obstetric tactics.
Patients and Methods: in the conditions of the Research Institute of Maternity and Infancy Protection, 12 cases of fetal urinoma were diagnosed in the period from 2018 to 2021. Ultrasound and doppler ultrasound of the kidneys were performed on all fetuses, and MRI was additionally used. In the postnatal period, a complete clinical laboratory and ultrasound examination of fetuses was performed to assess the preservation of kidney function.
Results: the mean gestation period at the time of urinoma diagnosis was 20.9±1.9 weeks. The period of admission to the hospital was 24.8±2.3 weeks. The average size of the detected urinoma in fetuses: longitudinal — 57.5±2.75 mm, transverse — 36.5±2.7 mm (maximum size 94×71 mm). In all cases, compression of adjacent organs was observed with large amounts of urinoma. When assessing renal blood flow, it was visualized only in 25% of cases. All patients with large urinomas in the fetus underwent intrauterine bypass surgery using the SDE-MED stent with the original pigtail shape (utility model patent No. 152166, 2015). In 72.7% (8) of cases, chronic renal failure was formed in the born children, and only in 27.3% (3) of cases, fetal renal function with urinomas remained intact.
Conclusion: in the early diagnosis of obstructive malformations in the fetal urinary system, the intrauterine bypass surgery in the renal cavitary system prevents the urinoma occurrence and preserves kidney function, which reduces the risk of renal failure in an infant. In urinoma in the fetus, especially large ones, intrauterine bypass surgery is necessary to decompress adjacent organs and preserve kidney function. However, it is worth noting that kidney function after the birth of an infant with this pathology can be preserved only in a quarter of all cases.
Keywords: congenital genitourinary anomalies, kidney function, obstructive uropathy, fetal urinoma, intrauterine bypass surgery, renal failure.
For citation: Kosovtsova N.V., Fedorova N.A., Pospelova Ya.Yu. Intrauterine fetal surgery of urinomas: outcome analysis. Russian Journal of Woman and Child Health. 2024;7(2):104–109 (in Russ.). DOI: 10.32364/2618-8430-2024-7-2-3.
ABOUT THE AUTHOR:
Natalia V. Kosovtsova — Dr. Sc. (Med.), Head of the Department of Biophysical Research Methods, Research Institute of Maternity and Infancy Protection; 1, Repin str., Yekaterinburg, 620028, Russian Federation; ORCID iD 0000-0002-4670-798X.
Yana Yu. Pospelova — C. Sc. (Med.), sonographer, postgraduate student of the Research Institute of Maternity and Infancy Protection; 1, Repin str., Yekaterinburg, 620028, Russian Federation; ORCID iD 0000-0002-9988-1199.
Natalia A. Fedorova — obstetrician-gynecologist, postgraduate student of the Research Institute of Maternity and Infancy Protection; 1, Repin str., Yekaterinburg, 620028, Russian Federation; ORCID iD 0000-0003-1474-4978.
Contact information: Natalia A. Fedorova, e-mail: fedotova.natasha95@mail.ru.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 02.08.2023.
Revised 25.08.2023.
Accepted 19.09.2023.
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