EXPERIMENTAL SHORT-TERM FETAL BLADDER OUTFLOW OBSTRUCTION: I. MORPHOLOGY AND CELL BIOLOGY ASSOCIATED WITH URINARY FLOW IMPAIRMENT

Purpose: In fetal sheep, combined urethral and urachal obstruction initiated at 75 days gestation and maintained for 30 days led to dysmorphic bladders similar to those found in humans with prune belly syndrome and to uniformly-disrupted kidney development. We aimed to create a less-severe model of fetal bladder outlet obstruction, more closely resembling infants with posterior urethral valves, and additionally to further our understanding of the role of the urachus. We hypothesized that milder morphological renal tract changes would occur after shorter-term experimental obstruction. Materials and Methods: Male fetal lambs were assigned to urachal and urethral ligation, urachal-only ligation or sham operations. Analyses were performed after nine days. Results: Concurrent urachal and urethral obstruction resulted in increased bladder weight, protein and DNA content. Detrusor smooth muscle was well-maintained, as assessed by light and electron microscopy, although urothelia showed basal apoptosis. Bladder obstruction led to hydronephrosis but failed to produce significant perturbations in urine osmolality. The nephrogenic cortex was either well-preserved or was replaced by glomerular cysts: the latter group tended to have heavier bladders. Urachal obstruction alone produced similar changes suggesting that the male sheep fetal urethra is a high-resistance conduit in midgestation. Conclusions: Concurrent urachal and urethral obstruction, or urachal obstruction alone, initiated in midgestation and maintained for nine days leads to bladder overgrowth but preserved renal tubular function. In future, it will be interesting to determine whether bladder decompression around this stage leads either to reversal of bladder overgrowth and/or ameliorates severe renal tract damage described after longer term fetal bladder outflow obstruction