Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity

R. Ruano; N. Sananes; C. Wilson; J. Au; C. J. Koh; P. Gargollo; A. A. Shamshirsaz; J. Espinoza; A. Safdar; A. Moaddab; N. Meyer; D. L. Cass; O. O. Olutoye; O. A. Olutoye; S. Welty; D. R. Roth; M. C. Braun; M. A. Belfort

doi:10.1002/uog.15844

Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity

R. Ruano, N. Sananes, C. Wilson, J. Au, C. J. Koh, P. Gargollo, A. A. Shamshirsaz, J. Espinoza, A. Safdar, A. Moaddab, N. Meyer, D. L. Cass, O. O. Olutoye, O. A. Olutoye, S. Welty, D. R. Roth, M. C. Braun, M. A. Belfort

Medical GYN and Obstetrics

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44 Scopus citations

Abstract

OBJECTIVE: To present a single center experience of a standardized prenatal multidisciplinary management protocol for fetal lower urinary tract obstruction (LUTO) and to propose a classification of fetal LUTO based on disease severity.

METHODS: This was a retrospective cohort study of 25 consecutive fetal patients with prenatal diagnosis of primary LUTO. Fetal intervention was offered after evaluation by a multidisciplinary team. Analyses were conducted using Bayesian methodology to determine predictors of survival at 6 months postpartum. Odds ratios (ORs) with 95% credibility intervals are reported.

RESULTS: Fifteen (60.0%) of the 25 patients referred for assessment survived to postnatal evaluation. Fetal vesicoamniotic shunt was placed in 14 (56.0%) patients with 12 survivors. Multivariable analysis suggested that fetal intervention (OR, 6.97 (0.88-70.16), Pr(OR > 1) = 96.7%), anhydramnios (OR, 0.12 (0.04-0.35), Pr(OR < 1) = 99.9%), favorable fetal urine analysis (OR, 3.98 (0.63-25.15), Pr(OR > 1) = 92.7%) and absence of renal cortical cysts (OR, 3.9 (0.66-24.2), Pr(OR > 1) = 93.3%) were predictors of survival.

CONCLUSIONS: Fetal intervention and fetal renal function were independently associated with postnatal survival of fetuses with LUTO. A classification based on the severity of disease is proposed.

Original language	English (US)
Pages (from-to)	476-482
Number of pages	7
Journal	Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
Volume	48
Issue number	4
DOIs	https://doi.org/10.1002/uog.15844
State	Published - Oct 1 2016

Keywords

cystoscopy
fetal lower urinary tract obstruction
fetal surgery
laser
posterior urethral valves
prenatal diagnosis
ultrasonography
vesicoamniotic shunt

ASJC Scopus subject areas

Radiological and Ultrasound Technology
Reproductive Medicine
Radiology Nuclear Medicine and imaging
Obstetrics and Gynecology

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10.1002/uog.15844

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Ruano, R., Sananes, N., Wilson, C., Au, J., Koh, C. J., Gargollo, P., Shamshirsaz, A. A., Espinoza, J., Safdar, A., Moaddab, A., Meyer, N., Cass, D. L., Olutoye, O. O., Olutoye, O. A., Welty, S., Roth, D. R., Braun, M. C., & Belfort, M. A. (2016). Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 48(4), 476-482. https://doi.org/10.1002/uog.15844

Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity. / Ruano, R.; Sananes, N.; Wilson, C. et al.
In: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, Vol. 48, No. 4, 01.10.2016, p. 476-482.

Research output: Contribution to journal › Article › peer-review

Ruano, R, Sananes, N, Wilson, C, Au, J, Koh, CJ, Gargollo, P, Shamshirsaz, AA, Espinoza, J, Safdar, A, Moaddab, A, Meyer, N, Cass, DL, Olutoye, OO, Olutoye, OA, Welty, S, Roth, DR, Braun, MC & Belfort, MA 2016, 'Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity', Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, vol. 48, no. 4, pp. 476-482. https://doi.org/10.1002/uog.15844

Ruano R, Sananes N, Wilson C, Au J, Koh CJ, Gargollo P et al. Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2016 Oct 1;48(4):476-482. doi: 10.1002/uog.15844

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abstract = "OBJECTIVE: To present a single center experience of a standardized prenatal multidisciplinary management protocol for fetal lower urinary tract obstruction (LUTO) and to propose a classification of fetal LUTO based on disease severity.METHODS: This was a retrospective cohort study of 25 consecutive fetal patients with prenatal diagnosis of primary LUTO. Fetal intervention was offered after evaluation by a multidisciplinary team. Analyses were conducted using Bayesian methodology to determine predictors of survival at 6 months postpartum. Odds ratios (ORs) with 95% credibility intervals are reported.RESULTS: Fifteen (60.0%) of the 25 patients referred for assessment survived to postnatal evaluation. Fetal vesicoamniotic shunt was placed in 14 (56.0%) patients with 12 survivors. Multivariable analysis suggested that fetal intervention (OR, 6.97 (0.88-70.16), Pr(OR > 1) = 96.7%), anhydramnios (OR, 0.12 (0.04-0.35), Pr(OR < 1) = 99.9%), favorable fetal urine analysis (OR, 3.98 (0.63-25.15), Pr(OR > 1) = 92.7%) and absence of renal cortical cysts (OR, 3.9 (0.66-24.2), Pr(OR > 1) = 93.3%) were predictors of survival.CONCLUSIONS: Fetal intervention and fetal renal function were independently associated with postnatal survival of fetuses with LUTO. A classification based on the severity of disease is proposed.",

keywords = "cystoscopy, fetal lower urinary tract obstruction, fetal surgery, laser, posterior urethral valves, prenatal diagnosis, ultrasonography, vesicoamniotic shunt",

author = "R. Ruano and N. Sananes and C. Wilson and J. Au and Koh, {C. J.} and P. Gargollo and Shamshirsaz, {A. A.} and J. Espinoza and A. Safdar and A. Moaddab and N. Meyer and Cass, {D. L.} and Olutoye, {O. O.} and Olutoye, {O. A.} and S. Welty and Roth, {D. R.} and Braun, {M. C.} and Belfort, {M. A.}",

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AU - Sananes, N.

AU - Wilson, C.

AU - Au, J.

AU - Koh, C. J.

AU - Gargollo, P.

AU - Shamshirsaz, A. A.

AU - Espinoza, J.

AU - Safdar, A.

AU - Moaddab, A.

AU - Meyer, N.

AU - Cass, D. L.

AU - Olutoye, O. O.

AU - Olutoye, O. A.

AU - Welty, S.

AU - Roth, D. R.

AU - Braun, M. C.

AU - Belfort, M. A.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - OBJECTIVE: To present a single center experience of a standardized prenatal multidisciplinary management protocol for fetal lower urinary tract obstruction (LUTO) and to propose a classification of fetal LUTO based on disease severity.METHODS: This was a retrospective cohort study of 25 consecutive fetal patients with prenatal diagnosis of primary LUTO. Fetal intervention was offered after evaluation by a multidisciplinary team. Analyses were conducted using Bayesian methodology to determine predictors of survival at 6 months postpartum. Odds ratios (ORs) with 95% credibility intervals are reported.RESULTS: Fifteen (60.0%) of the 25 patients referred for assessment survived to postnatal evaluation. Fetal vesicoamniotic shunt was placed in 14 (56.0%) patients with 12 survivors. Multivariable analysis suggested that fetal intervention (OR, 6.97 (0.88-70.16), Pr(OR > 1) = 96.7%), anhydramnios (OR, 0.12 (0.04-0.35), Pr(OR < 1) = 99.9%), favorable fetal urine analysis (OR, 3.98 (0.63-25.15), Pr(OR > 1) = 92.7%) and absence of renal cortical cysts (OR, 3.9 (0.66-24.2), Pr(OR > 1) = 93.3%) were predictors of survival.CONCLUSIONS: Fetal intervention and fetal renal function were independently associated with postnatal survival of fetuses with LUTO. A classification based on the severity of disease is proposed.

AB - OBJECTIVE: To present a single center experience of a standardized prenatal multidisciplinary management protocol for fetal lower urinary tract obstruction (LUTO) and to propose a classification of fetal LUTO based on disease severity.METHODS: This was a retrospective cohort study of 25 consecutive fetal patients with prenatal diagnosis of primary LUTO. Fetal intervention was offered after evaluation by a multidisciplinary team. Analyses were conducted using Bayesian methodology to determine predictors of survival at 6 months postpartum. Odds ratios (ORs) with 95% credibility intervals are reported.RESULTS: Fifteen (60.0%) of the 25 patients referred for assessment survived to postnatal evaluation. Fetal vesicoamniotic shunt was placed in 14 (56.0%) patients with 12 survivors. Multivariable analysis suggested that fetal intervention (OR, 6.97 (0.88-70.16), Pr(OR > 1) = 96.7%), anhydramnios (OR, 0.12 (0.04-0.35), Pr(OR < 1) = 99.9%), favorable fetal urine analysis (OR, 3.98 (0.63-25.15), Pr(OR > 1) = 92.7%) and absence of renal cortical cysts (OR, 3.9 (0.66-24.2), Pr(OR > 1) = 93.3%) were predictors of survival.CONCLUSIONS: Fetal intervention and fetal renal function were independently associated with postnatal survival of fetuses with LUTO. A classification based on the severity of disease is proposed.

KW - cystoscopy

KW - fetal lower urinary tract obstruction

KW - fetal surgery

KW - laser

KW - posterior urethral valves

KW - prenatal diagnosis

KW - ultrasonography

KW - vesicoamniotic shunt

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Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity

Abstract

Keywords

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