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

30 Citations (Scopus)

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

Fingerprint

Urinary Tract
Odds Ratio
Survival
Kidney
Prenatal Diagnosis
Postpartum Period
Survivors
Cysts
Fetus
Cohort Studies
Retrospective Studies

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

Fetal lower urinary tract obstruction : proposal for standardized multidisciplinary prenatal management based on disease severity. / Ruano, Rodrigo; 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.

In: Ultrasound in Obstetrics and Gynecology, Vol. 48, No. 4, 01.10.2016, p. 476-482.

Research output: Contribution to journalArticle

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 and Gynecology, vol. 48, no. 4, pp. 476-482. https://doi.org/10.1002/uog.15844
Ruano, Rodrigo ; 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. / Fetal lower urinary tract obstruction : proposal for standardized multidisciplinary prenatal management based on disease severity. In: Ultrasound in Obstetrics and Gynecology. 2016 ; Vol. 48, No. 4. pp. 476-482.
@article{e5a4a378cfeb441fa0a70133ea98878f,
title = "Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity",
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 = "Rodrigo 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.}",
year = "2016",
month = "10",
day = "1",
doi = "10.1002/uog.15844",
language = "English (US)",
volume = "48",
pages = "476--482",
journal = "Ultrasound in Obstetrics and Gynecology",
issn = "0960-7692",
publisher = "John Wiley and Sons Ltd",
number = "4",

}

TY - JOUR

T1 - Fetal lower urinary tract obstruction

T2 - proposal for standardized multidisciplinary prenatal management based on disease severity

AU - Ruano, Rodrigo

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

UR - http://www.scopus.com/inward/record.url?scp=84989940578&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84989940578&partnerID=8YFLogxK

U2 - 10.1002/uog.15844

DO - 10.1002/uog.15844

M3 - Article

C2 - 26690832

AN - SCOPUS:84989940578

VL - 48

SP - 476

EP - 482

JO - Ultrasound in Obstetrics and Gynecology

JF - Ultrasound in Obstetrics and Gynecology

SN - 0960-7692

IS - 4

ER -