Morphological changes of the bladder wall of fetuses with antenatally detected syndrome "megacystis"
Year: 2020, volume 16 Issue: №3 Pages: 779-785
Heading: Urology Article type: Original article
Authors: Deryugina L.A., Napsheva A.M., Medvedeva A.V., Rozhkova D.V., Maslyakova G.N.
Organization: Saratov State Medical University
Heading: Urology Article type: Original article
Authors: Deryugina L.A., Napsheva A.M., Medvedeva A.V., Rozhkova D.V., Maslyakova G.N.
Organization: Saratov State Medical University
Summary:
Objective: To determine the morphological features of the structure of the wall of the urinary bladder of the fetus with antenatally identified syndrome "megacystis". Material and Methods: Morphological investigations of the bladder wall of 11 fetuses of 12-21 weeks of gestation with diagnosed "megacystis" syndrome, obtained as a result of the termination of pregnancies, were carried out. The study was carried out using survey method, histochemical and immunohisto-chemical staining methods. Results: In all cases, the structure of the bladder wall with diagnosed syndrome "megacystis" sharply differed from the norm. The changes affected all layers, but the most pronounced pathological processes developed in the muscle layer, which did not differentiate into layers, the process was accompanied by a violation of the course of muscle fibers. Detrusor hypotrophy was observed in fetuses up to 18 weeks of gestation, the thickness of which decreased on average by 1,8 times. In fetuses with a gestational age of 21 weeks, the hypertrophic variant of the detrusor prevailed with an increase in its thickness by 2,6 times. In all cases, there was a significant depletion of the muscle wall with blood vessels up to 6% of the norm and a decrease in the number of nerve fibers to 24%. Conclusion. The study allowed to distinguish two variants of changes in the bladder at the syndrome "megacystis": "hypertrophic variant", characterized by an increase in the thickness of the muscle layer, and "hypotrophic variant", characterized by a decrease in the thickness of the muscle layer, which fits into the diagnostic concept of "detrusor dysplasia".
Keywords: detrusor dysplasia, megacystis syndrome
Bibliography:
1. Sebire N, Von Kaisenberg C, Rubio C, et al. Fetal megacystis at 10-14 weeks of gestation. Ultrasound Obstet Gynecol 1996; (8): 387-90.
2. Lishtvan L, Novikova I, Pribushenya O, et al. Fetal Megacystis in the first trimester of pregnancy. Prenatal diagnostics 2002; 1 (4): 272-7.
3. Taghavi К, Sharpe С, Stringer MD. Fetal megacystis: A systematic review. Journal of Pediatric Urology 2017; (13): 7-18.
4. Qin Wang, Jianming Zhang, Hui Wang, et al. Compound heterozygous variants in MYH11 underlie autosomal recessive megacystis-microcolon-intestinal hypoperistalsis syndrome in a Chinese family. Journal of Human Genetics 2019; (64): 1067-73.
5. Lee J, Kimber C, Shekleton P, et al. Prognostic factors of severe foetal megacystis. ANZ J Surg 2011; 81: 552-5.
6. Fontanella F, Duin L, Adama van Scheltema P, et al. Antenatal Workup of Early Megacystis and Selection of Candidates for Fetal Therapy. Fetal Diagn Ther 2019; (45): 155-61.
7. Deryugina L, Maslyakova G, Rozshkova D, Napsheva A. The structure of the urinary bladder wall of human fetuses in the antenatal period. Morphology 2019; 156 (6): 51-6.
8. Gilpin SA, Gosling JA. Smooth muscle in the wall of the developing human urinary bladder and urethra. J Anat 1983; 137 (Pt3): 503-12.
9. Lee JG, Macarak E, Coplen D, et al. Distribution and function of the adrenergic and cholinergic receptors in the fetal calf bladder during mid-gestational age. Neurourol Urodyn 1993; (12): 599-607.
10. Jakobsen LK, Trelborg KF, Simonsen U, et al. Development of contractile properties in the fetal porcine urinary bladder. Pediatric Research 2017; 83 (1-1): 148-55.
11. Osborne N, Bonilla-Musoles F, Machado L, et al. Fetal Megacystis Differential Diagnosis. J Ultrasound Med 2011; (30): 833-41.
12. Bernardes L, Aksnes G, Saada J, et al. Keyhole sign: how specific is it for the diagnosis of posterior urethral valves? Ultrasound in Obstetrics and Gynecology 2009; 34 (4): 419-23.
13. Kaefer M, Barnewolt C, Retik AB, et al. The sonographic diagnosis of infravesical obstruction in children: evaluation of bladder wall thickness indexed to bladder filling. J Urol 1997; (157): 989-91.
14. Williams CR, Pe'rez LM, Joseph DB. Accuracy of renal-bladder ultrasonography as a screening method to suggest posterior urethral valves. J Urol 2001; (165): 2245-7).
15. Deryugina L, Vishnevsky E, Kazanskaya I, etal. Prenatal diagnosis of urological diseases. Russian Bulletin of perinatology and pediatrics 2007; 52 (4): 50-54.
16. Deryugina L. Antenatal diagnosis of congenital diseases of the urinary system and substantiation of the tactics of managing children in the postnatal period: DSc diss. Moscow, 2008; 307 p.
17. Workman SJ, Kogan ВА. Fetal bladder histology in posterior urethral valves and prune belly syndrome. J Urol 1990; (144): 337-9.
18. Minninberg DT, Mantoya F, Okada K, et al. Subcellular muscle studies in the prune-belly syndrome. J Urol 1973; (109): 524-6.
19. Woolf A, Stuart H, Newman W Genetics of human congenital urinary bladder disease. Pediatric Nephrology 2013; 29 (3): 353-60.
| Attachment | Size |
|---|---|
| 2020_03_779-785.pdf | 1.29 MB |
Русский
English