Surgery Inside The Womb-- In-Depth Doctor's Interview
Ruben Quintero, M.D., Director of the Division of Maternal Fetal Medicine at the University of Miami and Eftichia Kontopoulos, M.D., Fetal Surgeon, talk about a new shunt for bladder obstructions in fetuses…
How does the new fetal surgery you are performing work?
Dr. Ruben Quintero: Fetal bladder obstruction is a condition that affects approximately one in 3,000 babies. Basically, the fetus is unable to urinate because there is a blockage in the passage of urine from the bladder into the amniotic cavity. Untreated, the condition will result in death of the baby approximately 90 percent of the time. Since 1982, physicians have tried to overcome the problem by placing a shunt inside the baby’s bladder and into the abdominal cavity. Unfortunately, that shunt fails to work in up to 60 percent of cases, so what we have done at the University of Miami and Jackson Memorial Hospital is devised a new shunt that doesn’t fail. It remains inside the baby and attached to the baby’s skin so that the urine can be derived appropriately from the bladder into the bag of waters.
What is the impact of this new shunt on fetal surgery?
Dr. Quintero: The idea here is that with this new treatment, we may be able to help these babies better because the device doesn’t fall out and doesn’t malfunction, which was a problem with the previous approaches.
Does the shunt stay inside the child when it is born?
Dr. Quintero: When the baby is born, the device is still attached, and it has to be removed by the pediatric urologist usually within the first few days of life.
How does it feel being able to tell a parent that their child isn’t going to suffer that fate?
Dr. Quintero: As a team, we have worked for many years trying to devise ways in which we could address this and other fetal conditions that unless treated, will result in either the death of the baby or severe damage to its organs. Here at the University of Miami and at Jackson Memorial Hospital, we have come up with this new treatment for babies with obstructions of the bladder.
Dr. Eftichia Kontopoulos: Apart from the technical and scientific part of it, coming up with a device that will actually have excellent results and will avoid having the complications of the previous devices. For us, the most important part is actually to see the baby after it’s born and follow through with it once we see that the results are actually taking place in a live human. We like to follow every baby that goes through our fetal therapy center, even after birth, and as far as possible, keep in contact with those children.
How big of a development is this device for fetal therapy?
Dr. Quintero: To put it into perspective, for the entire field and fetal therapy, this is a landmark development in our field. Basically, it’s one of the conditions that has challenged fetal therapists for many decades now with difficulties and frustrations with previous treatments, so we foresee this as a new beginning in the management of babies with bladder outlet obstruction, and in fact, an opportunity to learn finally what is the actual natural history of this condition if it is well treated in-utero.
What causes the condition?
Dr. Quintero: This is a sporadic condition, meaning it really doesn’t have a familial predisposition. However, we have seen families with repeated episodes of fetal bladder outlet obstruction, so there is a sub-group of patients that, in fact, may have a genetic predisposition.
What do you tell expectant mothers who have this condition, as far as how to take care of their bodies while they’re pregnant?
Dr. Kontopoulos: This is a rare condition so it doesn’t apply to our average patient that would walk in just for prenatal care or another high risk condition. It’s very sporadic, as Dr. Quintero mentioned, so overall, there’s nothing that the mother can do to prevent it in regards to lifestyle modification, diet, exercise, and so forth. It’s something that’s detected by ultrasound, and as we mentioned before, it is very, very rare, and can only be managed with specific fetal therapy or fetal surgery.
Are there basic things that you tell patients to do to stay healthy and to keep their babies healthy?
Dr. Kontopoulos: Aside from overall keeping healthy lifestyles, balanced diets, making sure that they have the appropriate intake of vitamins, folic acid, and having of course, access to prenatal care early on, which is very important, the cases that we deal with in our fetal therapy group are very specific and usually have already been seen by a general OB/GYN. They usually have prenatal care already, and because they have a very specific problem with the fetus, I refer them to our therapy group.
Is there anything that stands out about your patient, Carla’s surgery?
Dr. Quintero: In Carla’s surgery, we had to use different techniques to actually be able to drain the bladder of the baby. First of all, the bladder of the baby had collapsed from a previous intervention, so the baby’s abdomen was now full of urine. First, we had to get into the abdomen of the baby, then we had to get into the bladder of the baby using endoscopy, and then finally, we were able to place the new shunt in its correct place so that the baby could be adequately treated. From a technical point of view, it was a more challenging case than another standard baby with bladder outlet obstruction.
Carla mentioned in our interview that their child has some kidney problems – is that a result of the condition that was in-utero?
Dr. Quintero: Yes, the natural history of fetal bladder outlet obstruction has been marred by ineffective treatment. We are learning now, with this new treatment, what the actual impact of the obstruction and the function of the kidneys post-natally will be. In the case of the baby from Carla, we are following what its renal function will be in the future so that we can tell other mothers in the future what this condition actually means in post-natal life.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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If you would like more information, please contact:
Michaela Tregembo, Fetal Therapy Nurse Coordinator
University of Miami Miller School of Medicine
To read the full report Surgery Inside the Womb click here.