Z‐scores of fetal bladder size for antenatal differential diagnosis between posterior urethral valves and urethral atresia
Open accessAbstract
Objective: To construct reference values for fetal urinary bladder distension in pregnancy and use Z‐scores as a diagnostic tool to differentiate posterior urethral valves (PUV) from urethral atresia (UA). Methods: This was a prospective cross‐sectional study in healthy singleton pregnancies aimed at constructing nomograms of fetal urinary bladder diameter and volume between 15 and 35 weeks' gestation. Z‐scores of longitudinal bladder diameter (LBD) were calculated and validated in a cohort of fetuses with megacystis with ascertained postnatal or postmortem diagnosis, collected from a retrospective, multicenter study. Correlations between anatomopathological findings, based on medical examination of the infant or postmortem examination, and fetal megacystis were established. The accuracy of the Z‐scores was evaluated by receiver‐operating‐characteristics (ROC)‐curve analysis. Results: Nomograms of fetal urinary bladder diameter and volume were produced from three‐dimensional ultrasound volumes in 225 pregnant women between 15 and 35 weeks of gestation. A total of 1238 urinary bladder measurements were obtained. Z‐scores, derived from the fetal nomograms, were calculated in 106 cases with suspected lower urinary tract obstruction (LUTO), including 76 (72%) cases with PUV, 22 (21%) cases with UA, four (4%) cases with urethral stenosis and four (4%) cases with megacystis‐microcolon‐intestinal hypoperistalsis syndrome. Fetuses with PUV showed a significantly lower LBD Z‐score compared to those with UA (3.95 vs 8.83, P < 0.01). On ROC‐curve analysis, we identified 5.2 as the optimal Z‐score cut‐off to differentiate fetuses with PUV from the rest of the study population (area under the curve, 0.84 (95% CI, 0.748–0.936); P < 0.01; sensitivity, 74%; specificity, 86%). Conclusions: Z‐scores of LBD can distinguish reliably fetuses with LUTO caused by PUV from those with other subtypes of LUTO, with an optimal cut‐off of 5.2. This information should be useful for prenatal counseling and management of LUTO. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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At 18 and 22 weeks, the 95th centile for the longitudinal bladder measurement is 14 and 23 mm, respectively.
“At 18 and 22 weeks, the 95 th centile for the longitudinal bladder measurement is 14 and 23 mm, respectively 82 .”
From <scp>ISUOG</scp> Practice Guidelines (updated): performance of the routine mid‐trimester fetal ultrasound scan (2022) · cites this paper as [82]
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Salomon, L. J., Alfirevic, Z., Berghella, V., Bilardo, C. M., Chalouhi, G. E., Da Silva Costa, F., Hernandez‐Andrade, E., Malinger, G., Munoz, H., Paladini, D., et al. (2022) · Ultrasound in Obstetrics & Gynecology · doi:10.1002/uog.24888 · Cited by 436 · see citing works
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- Authors
- Fontanella, F., Groen, H., Duin, L. K., Suresh, S., & Bilardo, C. M.
- Affiliations
- Isala (NL)
- University Medical Center Groningen (NL)
- Mediscan Ultrasound Center Chennai India
- Corresponding author
- Fontanella, F.
- Venue
- Ultrasound in Obstetrics & Gynecology
- Publisher
- Wiley
- Published
- 2021-12
- Volume
- 58
- Issue
- 6
- Pages
- 875-881
- ISSN
- 0960-7692 (ISSN-L)
- 1469-0705
- PMC
- PMC9299997
- OpenAlex
- W3155883570
- Cited by
- 20
- References
- 29
- Citations by year
- 2025: 9 · 2024: 3 · 2023: 6 · 2022: 2
- FWCI
- 2.72
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Ultrasound in Obstetrics and Gynecology (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by-nc-nd)
- Pure Amsterdam UMC (submittedVersion, cc-by)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Urology and Nephrology Studies
- Health Sciences › Medicine › Surgery › Congenital Anomalies and Fetal Surgery
- Health Sciences › Medicine › Urology › Urological Disorders and Treatments
- Keywords
- posterior urethral valves, urethral atresia, Z-score, lower urinary tract obstruction, fetal megacystis, bladder volume, prenatal diagnosis, differential diagnosis, reference values, 3D ultrasound, megacystis-microcolon-intestinal hypoperistalsis syndrome, urethral stricture, prenatal counseling
- MeSH terms
- Urinary Bladder, Cross-Sectional Studies, Diagnosis, Diagnosis, Differential, Duodenum, Female, Fetal Diseases, Fetus, Humans, Organ Size, Pregnancy, Prospective Studies, Reference Values, Retrospective Studies, ROC Curve, Urethra, Urethral Obstruction, Ultrasonography, Prenatal, Nomograms, Lower Urinary Tract Symptoms
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