Fetal Surgery for Congenital Hydronephrosis

ALTHOUGH many fetal anatomic abnormalities can now be diagnosed by sonography, only a few will affect prenatal management.1 In the fetus with severe bilateral hydronephrosis secondary to urethral obstruction, the urinary tract should be decompressed as soon as possible in order to reduce the ongoing damage to the developing kidneys and lungs.2 However, fetal surgery in primates (including human beings) has proved difficult because the gravid uterus is exquisitely sensitive and thus liable to preterm labor and abortion. The recent development of successful anesthetic, surgical, and tocolytic techniques for fetal surgery in nonhuman primates3 allowed us to perform bilateral ureterostomies . . .