Abstract
Objectives
To predict the likelihood of spontaneous resolution of fetal megacystis and investigate the prognosis in infants with resolution of bladder enlargement during fetal life.
Methods
This was a retrospective cohort study. In the first trimester, fetal megacystis was defined by a longitudinal bladder diameter (LBD) ≥ 7 mm, and in the 2nd and 3rd trimester as a bladder failing to empty during an extended US examination. Resolution of bladder enlargement was defined as an empty or voiding bladder independently of vesicocentesis or bladder rupture. The megacystis ratio (MR) was defined as the ratio between longitudinal bladder diameter (LBD) and gestational age at the measurement.
Results
Out of 302 cases of megacystis, 59 regressed before birth (19.5%). The spontaneous resolution occurred before the 16th week in 23% of cases (15/66), and thereafter in 19.5% (44/225). All cases with early resolutions did not require any surgical urological intervention after birth. Moreover, the LBD at diagnosis had an AUC of 0.79 for the prediction of early resolution, with an optimal cut-off of 12 mm (sensitivity 100%, specificity 88%). In the late resolution group, 9 infants required a surgical intervention for lower urinary tract obstruction, and 3 infants showed severe vesico-ureteral reflux or persistent hydronephrosis after birth. For the prediction of late resolution, the MR presented an AUC of 0.72 with an optimal value of 1.4 (sensitivity 76%; specificity 68%).
Conclusions
Infants with spontaneous early resolution of fetal megacystis (before the 16th week) have an excellent prognosis. This finding supports the hypothesis of an early paraphysiological bladder enlargement recovering without sequelae. Conversely, late resolutions of bladder enlargement (after the 16th week) have more sequelae. The LBD in the 1st trimester and the MR, later in pregnancy, are reliable predictors of likelihood and timing of spontaneous resolution, and therefore of the final prognosis.
To predict the likelihood of spontaneous resolution of fetal megacystis and investigate the prognosis in infants with resolution of bladder enlargement during fetal life.
Methods
This was a retrospective cohort study. In the first trimester, fetal megacystis was defined by a longitudinal bladder diameter (LBD) ≥ 7 mm, and in the 2nd and 3rd trimester as a bladder failing to empty during an extended US examination. Resolution of bladder enlargement was defined as an empty or voiding bladder independently of vesicocentesis or bladder rupture. The megacystis ratio (MR) was defined as the ratio between longitudinal bladder diameter (LBD) and gestational age at the measurement.
Results
Out of 302 cases of megacystis, 59 regressed before birth (19.5%). The spontaneous resolution occurred before the 16th week in 23% of cases (15/66), and thereafter in 19.5% (44/225). All cases with early resolutions did not require any surgical urological intervention after birth. Moreover, the LBD at diagnosis had an AUC of 0.79 for the prediction of early resolution, with an optimal cut-off of 12 mm (sensitivity 100%, specificity 88%). In the late resolution group, 9 infants required a surgical intervention for lower urinary tract obstruction, and 3 infants showed severe vesico-ureteral reflux or persistent hydronephrosis after birth. For the prediction of late resolution, the MR presented an AUC of 0.72 with an optimal value of 1.4 (sensitivity 76%; specificity 68%).
Conclusions
Infants with spontaneous early resolution of fetal megacystis (before the 16th week) have an excellent prognosis. This finding supports the hypothesis of an early paraphysiological bladder enlargement recovering without sequelae. Conversely, late resolutions of bladder enlargement (after the 16th week) have more sequelae. The LBD in the 1st trimester and the MR, later in pregnancy, are reliable predictors of likelihood and timing of spontaneous resolution, and therefore of the final prognosis.
| Original language | English |
|---|---|
| Article number | OP25.07 |
| Pages (from-to) | 133-134 |
| Journal | Ultrasound in Obstetrics and Gynecology |
| Volume | 48 |
| Issue number | Suppl 1 |
| DOIs | |
| Publication status | Published - Sept 2016 |