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

Rodrigo 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

Research output: Contribution to journalArticle

33 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 languageEnglish (US)
Pages (from-to)476-482
Number of pages7
JournalUltrasound in Obstetrics and Gynecology
Volume48
Issue number4
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

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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

Cite this

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 and Gynecology, 48(4), 476-482. https://doi.org/10.1002/uog.15844