Fetal bladder rupture: A systematic review and management recommendations.

Introduction: Prenatal bladder rupture is a rare condition. The lack of data and coverage in textbooks presents significant challenges for its diagnosis and management.

Objective: This study aims to offer recommendations to assist clinicians dealing with this condition.

Study design: A systematic review was conducted by searching PubMed, Embase, and Science Direct databases, following PRISMA guidelines and using the JBI checklist. Search terms included "prenatal" or "fetal" "bladder rupture," "prenatal" or "fetal" "urinary ascites" as well as "bladder rupture and opioids". The search identified 2156 publications, which were screened; 27 were eligible for inclusion, allowing for a total of 28 cases to be analyzed.

Discussion: Although the data quality and reporting were heterogeneous, several key findings emerged: Prenatal bladder rupture is associated with lower urinary tract obstruction and has also been reported in cases involving maternal opioid use. Defects vary significantly and may resolve prenatally. At birth, some infants required extensive life support and immediate ascites drainage while others are asymptomatic. Postnatally, conservative management with drainage of the bladder, preferably via a transurethral catheter, and ascites management will likely lead to a spontaneous closure of the defect. If conservative management fails, surgical closure may be achieved via laparotomy or laparoscopy. Outcomes were generally reported to be favorable, though follow-up data were often insufficient.

Conclusion: The review highlights the variability in management of prenatal bladder rupture, emphasizing the need for multidisciplinary decision-making and further research to establish evidence-based guidelines.