Intrauterine correction of obstructive uropathies by bilateral nephroamnial bypass grafting of the fetal kidneys
Background. Renal dysplasia is a major cause of chronic renal failure in infants and is commonly associated with urinary tract obstruction. The presence of grades III–IV hydronephrosis or pathology of the posterior urethral valves in the fetus is known to be a prognostically unfavorable sign for the life and health of newborn infants and an indication for intrauterine correction. Vesicoamnial bypass grafting is the most commonly used method to correct infravesicular obstruction in clinical practice. However, there are other surgical procedures. As of now, the Ural Research Institute of Maternal and Infant Care, Ministry of Health of the Russian Federation, has introduced the nephroamnial bypass grafting for decompression of the fetal urinary tract, which reduces the risk of fetal complications (stent occlusion or expulsion) and improves prognosis, survival, and preservation of normal renal function. Intrauterine bypass grafting of the renal cavitary system is a pathogenetically justified treatment and is applicable to all types of urinary system obstruction in the fetus.Kosovtsova N.V., Pavlichenko M.V., Makarov R.A., Pospelova Ya.Yu., Chudakov V.B., Breynik A.L.
Case report. The paper describes three cases of bilateral nephroamnial bypass grafting of the fetal kidneys, by using the SDE-MED 3.0Fr/50mm stent with its original shape of pigtails, which has been designed at the Ural Research Institute of Maternal and Infant Care, Ministry of Health of the Russian Federation (Useful Model Patent for Endoprosthesis Stent under No. 152166 dated April 13, 2015).
Conclusion. The minimally invasive fetal kidney bypass grafting method developed and introduced into clinical practice allows the use of a shorter stent with its original pigtail shape, which provides its more reliable fixation in the fetal renal cavitary system. The bilateral bypass grafting technique ensures adequate urodynamics in both fetal kidneys, maintaining the normal function of the affected organs, preventing the formation of the secondarily contracted kidneys, thereby eliminating the unfavorable outcome of urinary system diseases in newborns. Both maternal and fetal complications of intrauterine interventions were not recorded.
Keywords
bilateral nephroamnial bypass grafting
bilateral hydronephrosis
infravesical obstruction
fetal surgery
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Received 10.03.2020
Accepted 09.12.2020
About the Authors
Natalya V. Kosovtsova, MD, Head of the Department of Biophysical Research Methods, doctor of the highest category, Ural Research Institute for the Protection of Mothers and Infants, Ministry of Health of Russian Federation. Tel.: +7(912)26-59-169. E-mail: kosovcovan@mail.ru. ORCID: 0000-0002-4670-798Х.620028, Russia, Yekaterinburg, Repina str., 1.
Maria V. Pavlichenko, candidate of medical sciences, Head of the Department of Young Children, pediatrician of the highest category, Ural Research Institute for the Protection of Mothers and Infants, Ministry of Health of Russian Federation. Tel.: +7(343)371- 40-92. E-mail: pavlichenko-mariya@mail.ru.
ORCID: 0000-0002-4941-9318. 620028, Russia, Yekaterinburg, Repina str., 1.
Roman A. Makarov, Ph.D., Head of the Department of Anesthesiology and Resuscitation, senior researcher at the Intensive Care Unit, Ural Research Institute for the Protection of Mothers and Infants, Ministry of Health of Russian Federation. Tel.: +7(343)359-88-78. E-mail: r_makarov_ekb@mail.ru. ORCID: 0000-0002-8067-5643.
620028, Russia, Yekaterinburg, Repina str., 1.
Yana Yu. Pospelova, doctor of ultrasound diagnostics, postgraduate student, Ural Research Institute for the Protection of Mothers and Infants, Ministry of Health of Russian Federation. Tel.: +7(922)113-79-53. E-mail: jana.pospelova@yandex.ru. ORCID: 0000-0002-9988-1199. 620028, Russia, Yekaterinburg, Repina str., 1.
Vladislav B. Chudakov, pediatric neurosurgeon, surgeon of the highest qualification category, Honored Doctor of the Russian Federation,
Regional Children’s Hospital No. 1 (CSTO). Tel.: +7(343)231-91-09. 620149, Russia, Yekaterinburg, Serafimy Deryabinoy str., 32.
Aleksey L. Breynik, anesthesiologist-resuscitator of the Department of Anesthesiology and Intensive Care, Ural Research Institute of Maternity and Childhood, Ministry of Health of Russian Federation. Tel.: +7(343)359-88-78. E-mail: leostinovich@yandex.ru. ORCID: 0000-0003-2592-4560. 620028, Russia, Yekaterinburg, Repina str., 1.
For citation: Kosovtsova N.V., Pavlichenko M.V., Makarov R.A., Pospelova Ya.Yu., Chudakov V.B., Breynik A.L. Intrauterine correction of obstructive uropathies by bilateral nephroamnial bypass grafting of the fetal kidneys.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2020; 12: 200-208 (in Russian)
https://dx.doi.org/10.18565/aig.2020.12.200-208
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