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WHEN TO INTERVENT AND WHEN NOT TO INTERVENT A MALE FETUS WITH
SEVERE PROGRESSIVE MEGACYST: AN ONGOING CHALLENGE
Abdurrahman ONEN
1
and Ahmet YALINKAYA
2
1) Onen Pediatric Urology Centre, Paediatric Surgery, Diyarbakir, TURKEY - 2) Dicle University, Obstetric and
Gynecology, Diyarbakir, TURKEY
INTRODUCTION
To determine possible criteria and indications for prenatal intervention in fetuses with severe progressive megacyst in an
attempt to improve postnatal outcome.
PATIENTS AND METHODS
A total of 56 male fetuses who diagnosed persistent severe progressive megacyst were prenatally followed prospectively
between 2001-2013. All of 26 fetuses who underwent prenatal intervention were matched with 30 fetuses who had
similar findings but did not undergo intervention as a control group. Our indication for prenatal intervention was
persistent severe megacyst associated with severe upper urinary dilation and oligohydroamnios.
RESULTS
Of 56 fetuses, 46 had severe PUV, 10 had urethral atresia. 33 patients had oligohydroamnios. Mean intervention age
was 25(18-29)weeks. Of 26 fetuses underwent prenatal intervention, 15 underwent needling alone, 11 underwent fetal
vesico-amniotic shunt placement one week after needling. Fetal urine parameters level was variable. Mean age of
delivery was 36(32-38)weeks. Of 30 control patients, 6 were normal, 10 died, 14 had CRF. Of 15 needling patients, 5
were normal, 4 died, 6 had CRF. Of 11 prenatal shunts patients, 4 were normal, 2 died, 4 had CRF.
CONCLUSIONS
Mortality rate was high in children associated with megacyst; it was particularly true for untreated cases. A significant
number of survivors develop CRF postnatally. Oligohydroamnios appears to be a predictive factor of irreversible renal
impairment. Fetuses with megacyst should be followed in every 2 weeks, those with bilateral grade-4 cases in every
week. Timely prompt prenatal intervention before the presence of oligohydroamnios may prevent permanent renal
damage, and thus improve postnatal outcome.