Interventions for Fetal Lower Urinary Tract Obstruction

JOURNAL TITLE: Donald School Journal of Ultrasound in Obstetrics and Gynecology

1. Emre Gunakan
2. Asli Azemi
3. Sertaç Esin
Publishing Year
Author Affiliations
    1. Department of Perinatology, Perinatal Medicine Center, Baskent University, Ankara, Turkey
    1. Department of Perinatology, Baskent University Ankara Hospital, Ankara, Turkey
    1. Department of Perinatology, Baskent University Ankara Hospital, Ankara, Turkey
  • Article keywords


    Aims and objectives: To review intervention methods for fetal lower urinary tract obstruction (LUTO). Background: Lower urinary tract obstruction is a group of congenital anomalies present in 2 to 3/10,000 live births and may be associated with 45 to 100% perinatal mortality. Prenatal ultrasound is the diagnostic tool for LUTO and also can be helpful for the selection of appropriate cases for antenatal treatment. Common ultrasonographic symptoms are distended bladder (megacystis), oligo/anhydramnios, hydronephrosis, and renal parenchymal changes especially in severe forms of LUTO. Recent studies in this field reported clinical scoring systems for LUTO instead of classic antenatal ultrasonographic criteria which allows for appropriate counseling and treatment of cases. Monitoring with serial ultrasonographic series, termination of pregnancy for selected cases, and prenatal fetal intervention are among management options of LUTO. In utero treatment is based on the possibility of removing the obstruction in the urethra and preventing renal damage as well as pulmonary hypoplasia by restoring the amniotic fluid volume. Results: Currently, vesicoamniotic shunting (VAS) and fetal cystoscopy are main choices for fetal therapy in LUTO. Retrospective and prospective cohort studies and a relatively small randomized controlled trial have demonstrated that these procedures may possibly improve perinatal survival. Conclusion: Future prospective trials may improve the efficacy of diagnostic criteria and timing for procedures and may provide us with more information about effect of LUTO on long-term renal performance during postnatal period. Clinical significance: Diagnosing fetal LUTO and treating accordingly may improve postnatal renal functions and survival of the baby.

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