Fetal surgery for severe lower urinary tract obstruction

Research output: Contribution to journalReview article

54 Scopus citations

Abstract

Fetal interventions have been proposed for treatment of severe lower urinary tract obstruction (LUTO), as this condition is associated with high rates of perinatal mortality and postnatal renal impairment. The rationale for in utero treatment for those cases is based on the possibility of relieving the obstruction, improving the amniotic fluid volume, and preventing renal and bladder damage. Candidates for fetal intervention should be rigorously selected based on the confirmation of severe LUTO (dilated bladder and bilateral hydronephrosis), oligohydramnios or anyhydramnios and 'favorable' fetal urinalysis (dependent on gestational age). Nowadays there are two different therapeutic options with specific technical approaches. Vesico-amniotic shunting is an easier procedure, but with a higher frequency of related complications. Fetal cystoscopy can be used for diagnostic purpose and for treatment of posterior urethral valves, with suggestive advantage of allowing a more physiological release of the obstruction. According to the literature, estimated survival rates and postnatal normal renal function frequencies are approximately 40 and 50% after vesico-amniotic shunting and 75 and 65% after fetal cystoscopy, respectively.

Original languageEnglish (US)
Pages (from-to)667-674
Number of pages8
JournalPrenatal Diagnosis
Volume31
Issue number7
DOIs
StatePublished - Jul 1 2011

Keywords

  • Cystoscopy
  • Fetal lower urinary tract obstruction
  • Fetal surgery
  • Laser
  • Posterior urethral valves
  • Prenatal diagnosis
  • Ultrasonography
  • Vesico-amniotic shunt
  • Vesicocentesis

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Genetics(clinical)

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