The Fetal Center offers three fetal surgical options for patients who have received a diagnosis of bladder outlet obstruction. They include fetal vesicoamniotic shunting, fetoscopic surgery to release the bladder outlet obstruction and open fetal vesicostomy. In addition, amnioport infusion may be offered as an adjunct therapy.
Babies most likely to benefit from surgery are those who are at risk of kidney injury and impairment of lung development due to bladder obstruction, but have not yet experienced irreversible kidney damage.
Deciding which treatment option to pursue, if any, is an emotional experience. The Fetal Center offers extensive counseling to patients about the diagnostic findings and treatment options, as well as a birth plan and the baby’s long-term prognosis. Our team is dedicated to giving parents the information and time they need to understand all of the various options and make the most appropriate decision for their family.
Fetal Vesicoamniotic Shunting
This is the most common operation for bladder outlet obstruction. It involves placing a shunt to allow urine to drain from the bladder into the amniotic space. This allows urine to bypass the obstruction and improves the baby’s lung development directly. However, kidney function is not always preserved.
This surgery is sometimes recommended for babies prior to 20 weeks’ gestation who have posterior urethral valve (PUV) and whose bodies have lost the ability to produce adequate urine to maintain normal amniotic fluid volume. Fetoscopic surgery, sometimes called fetoscopic cystoscopy, involves creating small surgical openings that allow placement of a fiberoptic endoscope (camera) and an instrument to cut away the tissue causing the obstruction. This relatively new innovation is limited to very few patients.
Open Fetal Surgery for Vesicostomy
This procedure is offered to a small number of carefully selected patients. Vesicostomy can correct the condition and prevent ongoing injury to the developing kidney. In fetal vesicostomy, the fetal abdomen is opened below the umbilical cord insertion. The bladder is opened and sutured to the fetal skin, allowing urine to flow properly.
Serial Amniotic Fluid Infusion via Amnioport
This therapy is sometimes recommended for patients whose baby does not produce adequate amounts of urine during fetal development. This novel therapy involves placing a port to allow repeated fluid infusion into the amniotic sac to replenish amniotic fluid throughout pregnancy as a way to support lung development. Following delivery, dialysis may be offered if indicated until a kidney transplant can occur in selected cases.