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Early urethral obstruction sequence in fetuses or fetal obstructive uropathy (FOU): A study of 15 cases.

Nadia Ben Jamaa, Radhouane Achour, Nesrine Ben Hadj Dahman, Sarra Mestri, Sihem Hmissa, Moncef Makni, Mohamed Tahar Yacoubi

Introduction: Early urethral obstruction sequence (FOU) consists on urethral obstruction, renal anomalies, ureterovesical dilatation, deficient abdominal wall, undescent testis and oligohydramnios. This condition poses problems of prenatal diagnosis and evaluation of renal impairment, etiology, management and genetic counseling. Our purpose is to study the patterns of urethral obstruction, the relation between obstructive uropathy and fetal phenotype and the type of renal anomalies in a retrospective study of 15 fetuses with F.O.U. An autopsy was performed with the dissection of the lower urinary tract and a histological study of kidneys in each case. Results: The gestational age was ranged between 13 and 33 weeks. The sex ratio was 13/2. Prenatal findings were: urinary tract abnormalities and oligohydramnios in 9 cases, nonspecified malformations in 3 cases, hydrocephalus in 1 case. Karyotype was normal in all the cases. Medical termination of pregnancy was performed in all cases. Anatomic obstruction of the urethra was found in 8 cases with 3 patterns (Atresia: 3 cases, stenosis: 3 cases, Urethral valve: 2 cases). Anatomic obstruction was absent in 7 cases. Megacystis was present in 14 cases, thin vesical wall in 12 cases, megaureters in 6 cases, bilateral hydronephrosis in 5 cases, Renal cystic changes in all cases and dysplastic changes in 11 cases. Conclusion: Renal changes in F.O.U. depend on the duration of obstruction. Anatomic obstructions of the urethra should be systematically demonstrated since they are the major cause of this phenotype. Prenatal diagnosis is compulsory indicating medical termination of pregnancy in such conditions.