Congenital urinary tract obstruction

Cheung, Ka Wang; Morris, R.; Kilby, Mark D.

doi:10.1016/j.bpobgyn.2019.01.003

Cited by 23 publications

(29 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although the diagnostic accuracy is challenging, fetal LUTO can be detected by screening ultrasonography during the late first and second trimesters of pregnancy, characteristically presenting megacystis, various degrees of hydronephrosis and dilated ureters, macro-or microcysts in the kidney parenchyma and oligohydramnios [2,3]. Untreated fetal LUTO has up to a 45% perinatal mortality rate and approximately 30% morbidity in survivors [4,5], principally due to lung hypoplasia and renal failure.…”

Section: Introductionmentioning

confidence: 99%

Decreased biventricular myocardial deformation in fetuses with lower urinary tract obstruction

Zhou

et al. 2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

Background To observe myocardial deformations in fetuses with isolated lower urinary tract obstruction (LUTO) and identify the correlation between myocardial deformation and the severity of obstruction. Methods The strain (S), strain rate in systole (SRs) and strain rate in diastole (SRd) of the left and right ventricles at the first examination were prospectively analyzed and compared between fetuses with isolated LUTO and gestational age (GA)-matched normal control fetuses. Multiple regression analyses were used to assess the obstructive factors for impaired strain and strain rate, and the independent variables included bladder volume, sum of the bilateral pelvic diameters, sum of the bilateral ureteral diameters, mean bilateral renal artery pulsatility index, and amniotic fluid index. Results Thirty-six fetuses with isolated LUTO and 36 normal controls were enrolled. Overall, decreased S, SRs and SRd of both ventricles were noted in fetuses with LUTO ( p < 0.001). Moreover, S and SR were significantly negatively related to distended bladder volume ( p < 0.001). Conclusions Fetuses with LUTO demonstrated decreased left and right myocardial deformation, and this impaired cardiac dysfunction was correlated with the urinary bladder volume. Evaluating the myocardial deformation in fetal LUTO could provide information to aid in parental counselling and intervention monitoring.

show abstract

Section: Introductionmentioning

confidence: 99%

Decreased biventricular myocardial deformation in fetuses with lower urinary tract obstruction

Zhou

et al. 2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…• Element Considerations for Fetal Identification, Counseling, Informed Consent, and Maternal Preparation. Subject directed reviews for fetal LUTO provide comprehensive summation for element identification and consideration [11][12][13][14][15].…”

Section: Results/interventions: Identification Of Potential Evidenced-based Protocol Elements For Development Of An Eras-luto Guidelinementioning

confidence: 99%

Evaluation of the Fetal Therapy Evidence in Lower Urinary Tract Obstruction: Would an ERAS Guideline Improve Outcomes?

Wilson¹,

Nelson²

2021

Fetal Diagn Ther

View full text Add to dashboard Cite

Background: Pregnancies that are prenatally identified to have fetal anomalies are complex and require expert multidisciplinary care. As many conditions can impact the fetus prenatally and require intervention, an enhanced recovery after surgery (ERAS) for lower urinary tract obstruction (LUTO) is being evaluated to determine the level of evidenced-based data available. Problem: The percutaneous ultrasound-guided fetal surgery procedure for bladder neck obstruction is the focus for elements of preoperative counseling, intraoperative procedure/risk complications, and postoperative management. Methods: A quality improvement review Squire 2.0 (2000–2020) was undertaken for the percutaneous LUTO fetal surgery shunting (lower urinary tract obstruction), process and procedure which require 2 process pathways, one to evaluate the fetal candidate and a second to treat. This structured review is focused on identifying the process elements to allow the determination of the number of evidenced-based elements that would allow for audit and measurement of the clinical element variance for comparative feedback to the individual surgical provider or surgery center. Interventions: Titles and abstracts were screened to identify potentially relevant articles with priority given to meta-analyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series. Results: A series of potential clinical elements for the diagnostic fetal evaluation and for the 3 protocol areas of surgical care for the procedures (pre-, intra-, and postoperative care) are identified using an ERAS-like process. Conclusions: The identified clinical elements have the potential for ERAS-LUTO fetal therapy guideline. Multidisciplinary collaboration (surgeon, anesthesia, nursing, imaging, and laboratory) is required for ERAS quality improvement in the pre-, intra-, and postoperative processes. Process elements in each of the operative areas can be audited, evaluated, compared, and modified/improved.

show abstract

“…In 90% of the cases with a normal karyotype, megacystis (7-15 mm) resolves spontaneously before the 20th gestational week. On the contrary, spontaneous resolution is unlikely in neonates with a bladder length >12 mm before the 18th week or >15 mm at the 20th week of gestation (15)(16)(17). In 2019, Fontanella et al published a prognostic score to predict the severity of cLUTO using antenatal diagnostics.…”

Section: Discussionmentioning

confidence: 99%

Postnatal Management in Congenital Lower Urinary Tract Obstruction With and Without Prenatal Vesicoamniotic Shunt

2021

View full text Add to dashboard Cite

Purpose: Congenital lower urinary tract obstruction (cLUTO) includes a heterogeneous group of conditions caused by a functional or mechanical outlet obstruction. Early vesicoamniotic shunting (VAS) possibly reduces the burden of renal impairment. Postpartum, pediatric urologists are confronted with neonates who have a shunt in place and a potentially impassable urethra with a narrow caliber. Early management of these patients can be challenging. Here, we would like to share the approach we have developed over time.Materials and Methods: We conducted a single-center retrospective analysis from 2016 to 2020 and included all patients diagnosed with cLUTO. Data focusing on time point and type of intervention was collected. Furthermore, patients with temporary diversion via a percutaneous VAS were selected for a more detailed review.Results: In total, 71 cases of cLUTO were identified during the study period. Within this group, 31 neonates received postnatal management and surgical intervention in our center. VAS was performed in 55% of these cases (N = 17). The postnatal treatment varied between transurethral or suprapubic catheterization and early Blocksom vesicostomy. In five infants with VAS, the urinary drainage was secured through the existing VAS by inserting a gastric tube (N = 1) or a 4.8 Fr JJ-stent (N = 4). To our knowledge, this is the first report of a stent-in-stent scheme, which can remain indwelling until the definite treatment.Conclusion: Having a secure urine drainage through a VAS allows the often premature infant to grow until definite surgery can be performed. This avoids placing a vesicostomy, which requires anesthesia.

show abstract

Congenital urinary tract obstruction

Cited by 23 publications

References 52 publications

Decreased biventricular myocardial deformation in fetuses with lower urinary tract obstruction

Decreased biventricular myocardial deformation in fetuses with lower urinary tract obstruction

Evaluation of the Fetal Therapy Evidence in Lower Urinary Tract Obstruction: Would an ERAS Guideline Improve Outcomes?

Postnatal Management in Congenital Lower Urinary Tract Obstruction With and Without Prenatal Vesicoamniotic Shunt

Contact Info

Product

Resources

About