Biometric and morphological features of the fetal bladder in
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Inadequacy between currently available fetoscopes and anatomical constraints of the fetal bladder account for most technical difficulties during fetal cystoscopies (FC) in lower urinary tract obstruction (LUTO). The aim of this anatomical study was to assess by MRI the variations in three bladder angles bladder-neck angle, vesicourethral angle, dome-urethra angle with gestational age, bladder volume or the presence of LUTO

46 MRIs of male fetuses (17 LUTO at 28.1 weeks [17.3-35] and 29 controls at 29.9 weeks [21.9-35] matched for GA) were reviewed. Mann-Whitney’s test was used to compare angle values between groups. Variations according to GA and bladder volume were determined using ANOVA. A reliability study was performed using Bland-Altman’s method and Lin’s correlation coefficient. The BNA was higher in LUTO fetuses: 127.1° versus 111.2°. There was no difference in the DUA. No statistical analysis was conducted on the VUA since it was not measurable in most control fetuses. Variance analysis showed no variation of the three angles with bladder volume in LUTO and in control fetuses. The BNA in LUTO fetuses was the only angle to vary with GA and was higher after 25 weeks. Reliability study showed an acceptable bias for both intra- and inter-investigator reproducibility for all three angles. Surgical difficulties could be anticipated from virtual MRI

The BNA is approximately 15° higher in LUTO fetuses and the angle between the posterior urethra and the bladder axis averages 117°. The development of a customized
fetal cystoscope should help overcome the current technical challenges of FC.