Prenatal incision of ureterocele causing bladder outlet obstruction: a multicenter case series

We reviewed data from a cohort of fetuses with ureterocele diagnosed and operated prenatally in four fetal therapy centers. Inclusion criteria were (1) ureterocele confirmed on detailed fetal ultrasound examination, (2) absence of additional fetal malformations, and (3) fetal intervention to decompress the ureterocele with local institutional review boards' approval. Data on sonographic follow-up, obstetrical, neonatal outcome, and postnatal evaluation were collected. Ten cases of prenatally treated ureterocele are described. Six cases benefited from a fetoscopy for laser incision and decompression, two cases had an ultrasound guided puncture before resorting to a fetoscopy with laser incision, one case had a balloon catheterization under ultrasound guidance, and one case had an ultrasound-guided opening of the ureterocele with a laser fiber passed through a 20-gauge needle. Mean gestational age at diagnosis was 21.6 GW. Two cases underwent termination of pregnancy. The remaining eight cases recovered normal amniotic fluid volume and delivered a liveborn child at a mean gestational age of 38.6 GW with normal creatinine levels during the first week of life. Prenatal incision provided complete treatment of severely obstructive ureteroceles in 80% of the cases and allowed improvement of urinary electrolytes, renal size and echogenicity, bladder filling in all survivors, and recollection of normal amniotic fluid volume, in case of oligoanhydramnios. © 2017 John Wiley & Sons, Ltd.     

Timber Certification: Where Is the Voice of the Biologist?

Editor's note: This Conservation Forum begins with a reprinted editorial by Elizabeth Bennett from the August 2000 issue of Conservation Biology . Several papers were submitted in repsonse to that piece, and it is reprinted here to start this forum.     

DETECTING CUMULATIVE EFFECTS ON HEADWATER STREAMS IN THE ROUTT NATIONAL FOREST,COLORADO1

ABSTRACT: This study evaluated the use of a modified pebble count procedure (Bevenger and King, 1995) to detect cumulative watershed effects on headwater streams in the Routt National Forest in northcentral Colorado. The 42 sample reaches were stratified by disturbance (reference or disturbed) and geologic terrene (granitic or mixed sedimentary-volcanic). Water surface slope was a significant control on the number of fine particles in the reference reaches in both terranes, and the data from the disturbed reaches were adjusted accordingly. The disturbed reaches in the granitic terrene generally had a higher percentage of fine particles, and the adjusted number of fine particles was significantly correlated with the number of road crossings. Disturbed reaches in the sedimentary-volcanic (s-v) terrane generally did not have significantly more fine particles, nor were the adjusted numbers of fine particles significantly correlated with any management index. The lack of significant trends in the s-v streams is probably due to differences in weathering between the two rock types, and the location of the sample reach relative to sedimentary outcrops. Two other procedures were also used to assess cumulative watershed effects, with the Pfankuch channel stability rating yielding stronger and more consistent differences between the reference and the disturbed streams than the Tarzwell substrate ratio. We conclude that it may be difficult to define a standard reference condition, and that the number of road crossings is more strongly correlated with the number of fine particles than equivalent clearcut area.