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) |
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Pages (from-to) | 476-482 |
Number of pages | 7 |
Journal | Ultrasound in Obstetrics and Gynecology |
Volume | 48 |
Issue number | 4 |
DOIs | |
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
- Obstetrics and Gynecology
- Radiology Nuclear Medicine and imaging
- Reproductive Medicine