Predicting the Future of Patients with Obstructive Uropathy—A Comprehensive Review

Richter, Juliane; Rickard, Mandy; Kim, Jin Kyu; Erdman, Lauren; Lorenzo, Armando J.; Chua, Michael

doi:10.1007/s40124-022-00272-1

Cited by 2 publications

(3 citation statements)

References 73 publications

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“…Hence, standardization and utilization of diagnostic scores (e.g., for prenatal differentiation between LUTO and underlying pathologies 16 or the Z-score 17 ) and artificial intelligence-based tools such as the Toronto Nomogram 4 or convolutional neural network models 18 can be a valuable addition to assist in prenatal diagnostics in order to further improve detection rates. 19 In addition, cases of late-onset or atypical presentation of LUTO might not be detected at mid-trimester ultrasound screening increasing the risk of a missed diagnosis. Thus, initiation of routine third trimester screening In the present study, LUTO affected mainly male fetuses and a suspected LUTO diagnosis led to constantly high termination rates of nearly 50% during the observation period, confirming previously published data.…”

Section: Discussionmentioning

confidence: 99%

Trends in Management of Fetuses with Suspected Lower Urinary Tract Obstruction (LUTO): A High-Risk Fetal and Pediatric Center Experience in a Universal-Access-to-Care System

Richter,

Doktor,

Good

et al. 2023

Eur J Pediatr Surg

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Introduction Neonates with lower urinary tract obstruction (LUTO) experience high morbidity and mortality associated with the development of chronic kidney disease. The prenatal detection rate for LUTO is less than 50%, with late or missed diagnosis leading to delayed management and long-term sequelae in the remainder. We aimed to explore the trends in prenatal detection and management at a high-risk fetal center and determine if similar trends of postnatal presentations were noted for the same period. Methods Prenatal and postnatal LUTO databases from a tertiary fetal center and its associated pediatric center between 2009 and 2021 were reviewed, capturing maternal age, gestational age (GA) at diagnosis, and rates of termination of pregnancy (TOP). Time series analysis using autocorrelation was performed to investigate time trend changes for prenatally suspected and postnatally confirmed LUTO cases. Results A total of 161 fetuses with prenatally suspected LUTO were identified, including 78 terminations. No significant time trend was found when evaluating the correlation between time periods, prenatal suspicion, and postnatal confirmation of LUTO cases (Durbin–Watson [DW] = 1.99, p = 0.3641 and DW = 2.86, p = 0.9113, respectively). GA at referral was 20.0 weeks (interquartile range [IQR] 12, 35) and 22.0 weeks (IQR 13, 37) for TOP and continued pregnancies (p < 0.0001). GA at initial ultrasound was earlier in terminated fetuses compared to continued (20.0 [IQR 12, 35] weeks vs. 22.5 [IQR 13, 39] weeks, p < 0.0001). While prenatal LUTO suspicion remained consistently higher than postnatal presentations, the rates of postnatal presentations and terminations remained stable during the study years (p = 0.7913 and 0.2338), as were GA at TOP and maternal age at diagnosis (p = 0.1710 and 0.1921). Conclusion This study demonstrated that more severe cases of LUTO are referred earlier and are more likely to undergo TOP. No significant trend was detected between time and prenatally suspected or postnatally confirmed LUTO, highlighting the need for further studies to better delineate factors that can increase prenatal detection.

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Section: Discussionmentioning

confidence: 99%

Trends in Management of Fetuses with Suspected Lower Urinary Tract Obstruction (LUTO): A High-Risk Fetal and Pediatric Center Experience in a Universal-Access-to-Care System

Richter,

Doktor,

Good

et al. 2023

Eur J Pediatr Surg

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“…In the absence of VUR or with worsening HUN, diuretic renography may be considered to determine function and drainage time. 39 If an obstruction is diagnosed, there are various surgical management options, including ureterovesicostomy, cutaneous ureterostomy, endoscopic balloon dilatation and ureteral reimplant. [40][41][42][43] The success rates of these procedures vary, and the chosen intervention is often based on institutional and surgeon preferences.…”

Section: Hydroureteronephrosis and Vurmentioning

confidence: 99%

“…This ultrasound may be performed as an outpatient if the newborn is otherwise clinically well; however, in the presence of red flags such as features of LUTO or voiding concerns, this should be completed before the child is discharged from the hospital. In the absence of VUR or with worsening HUN, diuretic renography may be considered to determine function and drainage time 39 . If an obstruction is diagnosed, there are various surgical management options, including ureterovesicostomy, cutaneous ureterostomy, endoscopic balloon dilatation and ureteral reimplant 40–43 .…”

Section: Postnatal Management and Natural Historymentioning

confidence: 99%

Fetal urinary tract dilation: What to tell the parents

Nulens,

Lorenzo,

Dos Santos

et al. 2023

Prenatal Diagnosis

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Urinary tract dilation (UTD), which refers to the abnormal dilation of the urinary collection system, is the most common finding on prenatal ultrasound and presents with varying severity, presentation, etiology, and prognosis. Prenatal classification and risk stratification aim to prevent postnatal complications, such as urinary tract infections and further kidney dysfunction. Parents expecting a child with UTD should be counseled by a multidisciplinary team consisting of maternal‐fetal medicine specialists, and pediatric urology and nephrology providers. This review summarizes the key points in the diagnostic evaluation and management during the prenatal and initial postnatal period, focusing on the information that should be provided to future parents. We address frequently asked parental questions and concerns that our multidisciplinary clinical practice faces.

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Predicting the Future of Patients with Obstructive Uropathy—A Comprehensive Review

Cited by 2 publications

References 73 publications

Trends in Management of Fetuses with Suspected Lower Urinary Tract Obstruction (LUTO): A High-Risk Fetal and Pediatric Center Experience in a Universal-Access-to-Care System

Trends in Management of Fetuses with Suspected Lower Urinary Tract Obstruction (LUTO): A High-Risk Fetal and Pediatric Center Experience in a Universal-Access-to-Care System

Fetal urinary tract dilation: What to tell the parents

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