Fetal lower urinary tract obstruction caused by sacrococcygeal teratoma: A case report

Background: Fetal lower urinary tract obstruction (LUTO) is a rare occurrence that is usually associatedwith major morbidity and mortality after birth. It has an incidence of 2.2 in 10000 pregnancies. In males,the most common cause is persistent posterior urethral valves (50-60%). Other causes include urethralatresia with a poor prognosis. Most fetuses that survive to term with LUTO need dialysis or renaltransplant.Case presentation: A 35-year-old gravida 3 presented for routine antenatal follow-up. Her antenatalfollow-up remained normal until she underwent a growth scan at 33 weeks. Ultrasound revealed a fetuswithin normal growth centiles, but the renal system had features of obstruction. Renal calyces weredilated with hyperechoic renal parenchyma. The bladder was also markedly distended and had athickened wall, and a keyhole sign was present. There was a multicystic lesion in the sacral regionwithout blood flow on Doppler imaging. There was oligohydramnios. She had fetal vesicocentesis, whichrevealed normal kidney function. She had serial fetal vesicocentesis, and renal ultrasound showedimprovement in the corticomedullary differentiation of the kidney. At 38 weeks, the patient underwent acesarean delivery. Imaging studies showed a sacrococcygeal teratoma that was causing pressure on therenal system. This was excised, and the patient was allowed to return home on physiotherapy. Renalfunction test after delivery remained normal.Conclusion: Fetal lower urinary tract obstruction in males is mostly managed using the placement ofvesicoamniotic shunts or stents. In male fetuses with posterior urethral valves, ablation is performed inutero using cystoscopy. In this case report, LUTO was managed by serial vesicocentesis, whichpreserved renal function. In low-resource settings where surgery is not available, serial vesicocentesiscan be performed to relieve obstruction.