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 justif ied treatment and is applicable to all types of urinary system obstruction in the fetus. 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.

bilateral nephroamnial bypass grafting, bilateral hydronephrosis, infravesical obstruction, fetal surgery