In utero surgical treatment of fetal obstructive uropathy: A new comprehensive approach to identify appropriate candidates for vesicoamniotic shunt therapy

The Percutaneous shunting in Lower Urinary Tract Obstruction (PLUTO) study and randomised controlled trial: evaluation of the effectiveness, cost-effectiveness and acceptability of percutaneous vesicoamniotic shunting for lower urinary tract obstruction

“…58 Four fetuses in the VAS arm and five in the conservative arm were karyotyped; all were normal males (46, XY).…”

“…A total of 23 articles 5,24,29,39,40,42,[51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] met the selection criteria. All of the studies were observational studies and of poor quality ( Figure 6).…”

Prenatal diagnosis from fetal urine in bladder outlet obstruction: Success rates for traditional cytogenetic evaluation and interphase fluorescence in situ hybridization

“…Criteria for selection of candidates for fetal bladder shunting include those with favorable prognostic signs based on a thorough ultrasound examination evaluating the appearance of the fetal kidneys and ruling out other congenital malformations, sequential fetal urine electrolyte analysis, ␤ 2 -microglobulin concentration, and chromosome analysis. 2,3 If favorable sonographic, biochemical, and cytogenetic results are obtained and the fetus is at an appropriate gestational age to consider in utero intervention (usually between 16 and 32 weeks), expeditious placement of a vesicoamniotic shunt is recommended to bypass the bladder outlet obstruction, relieve the increased pressure in the urinary tract which has led to vesicoureteral reflux and hydronephrosis, and allow amniotic fluid to accumulate to reduce the risk or severity of pulmonary hypoplasia.…”

Prenatal intervention for urinary obstruction and myelomeningocele

“…Retrospective analysis of individual urine constituents have shown that a sodium of less than 100 mEq/L, osmolality less than 210 mOsm/L and chloride less than 90 mEq/L, if accompanied by lack of ultrasonographic evidence of dysplasia, are helpful in predicting residual fetal renal function. By categorizing patients according prognosis, assessment of the potential efficacy of intervention ca be made (39 (41) proposed providing transient relief of obstruction by vesicocentesis followed by sequential sampling (3 or 4 samples over several days) of urinary electrolytes. This was felt to provide an assessment of the severity of the renal injury and potential for reversibility of renal injury.…”

“…This was felt to provide an assessment of the severity of the renal injury and potential for reversibility of renal injury. Those fetuses that experience an improvement in their biochemical parameters following decompression may benefit most from interventional therapy (41). Others have suggested that sampling of fetal urine electrolytes and osmolarity is not an optimal method to evaluate fetal renal function and recommend continued search for a better substance (42)(43)(44).…”