Estudo morfológico da genitália externa, bexiga e uretra em fetos femininos: alterações geniturinárias associadas à anencefalia

Abstract

Our hypothesis in this paper is that anencephaly impacts the development of the external genitalia and the female lower urinary tract during the human fetal period. The objective of this study is to compare the biometric parameters of the external genitalia, bladder and urethra of female fetuses with and without neural tube defects. 34 female fetuses (22 normal and 12 anencephalic) were studied, aged between 12 and 22 weeks after conception . The fetuses were initially placed in the classic lithotomy position and before the fetal dissection, the female external genitalia were photographed with a digital camera. Then, with the aid of a microscope, the fetuses were submitted to pelvic dissection and individualization of the structures of the urinary tract (bladder and urethra). The biometric parameters were recorded and the measurements were made using the Image J software, version 1.46r. The length and width of the clitoris, clitoris to anus distance, length and width of the vaginal opening, distance from the vaginal opening to the labia majora, anogenital distance, length and width of the bladder and urethra were evaluated. For statistical analysis, the Wilcoxon-Mann-Whitney test was used (p <0.05). We observed a significant difference between some measures between groups: the width of the vaginal open is the largest in anencephalic fetuses and the length of the vaginal opne, the clitoris to anus distance, the distance from the vaginal open to labia majora are greater in normal group. For clitoral length and width, no statistical differences were found. There was also no statistical significance in the anogenital distance between the groups (normal 2.32 mm ± 2.46-6.42 / SD 2.17 ± vs anencephalic 3.93 mm ± 1.15-6.65 / SD = 1, 93; p = 0.499). For urinary tract, we identifie statistical significance between the groups for measures of bladder and urethra length. We did not observe significant differences in the width of the bladder and urethra when comparing the two groups. Anencephalic fetuses showed some changes in the development of the external genitalia, but the anogenital distances do not show significant variations between groups. We observed significant differences in the development of the bladder and urethra in fetuses with anencephaly during the studied fetal period, proving that anencephaly is capable of impacting the development of the female lower urinary tract