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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

70 Scopus citations


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
Issue number4
StatePublished - Oct 1 2016


  • 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
  • Obstetrics and Gynecology
  • Radiology Nuclear Medicine and imaging
  • Reproductive Medicine


Dive into the research topics of 'Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity'. Together they form a unique fingerprint.

Cite this