Congenital lower urinary tract obstruction: a population‐based epidemiological study

Abstract

Objective To determine the prevalence and outcome of lower urinary tract obstruction (LUTO), including the sensitivity of antenatal diagnosis.Design A retrospective population-based study. Setting Regional population-based congenital anomalies register (WMCAR).Population Fetuses affected by LUTO delivered between 1995 and 2007 to women resident in the West Midlands.Methods Cases were selected from the WMCAR using codes and keyword terms from the International Classification of Diseases, tenth revision (ICD10). Diagnoses were validated using additional data sets from Regional Fetal Medicine, Perinatal Pathology and Paediatric services.Main outcome measures Rates of prevalence, prenatal diagnosis and mortality, with trends.Results There were 284 LUTO cases in 851 419 births during the study period, representing a total prevalence of 3.34 (2.95-3.72) per 10 000 births, and this prevalence did not change significantly over time. The prevalence of LUTO was significantly higher in Black and minority ethnic groups when compared with white Europeans (OR 2.38; 95% CI 1.87-3.03), and are associated with area-based deprivation measures (P < 0.01). Of all LUTO cases, 221 (77.8%) were isolated, and the remainder were associated with other structural or chromosomal anomalies. The most common subtype was posterior urethral valves (PUVs; n = 179, 63%). In total there were 211 (74.3%) cases of isolated, nonfemale, singleton fetuses that fitted the referral criteria for in utero vesico-amniotic shunting, giving a prevalence of 2.48 (2.14-2.81) per 10 000 live births. Within this group, the prenatal diagnosis rate was 46.9% (99/211).Conclusion This is the largest population-based study of LUTO that has been performed to date, and provides accurate estimates for prevalence. The low prevalence and relatively low rate of antenatal detection limit the number of cases amenable to prenatal surgical intervention.

Fetal Megacystis: Experience of a Single Tertiary Center in Switzerland over 20 Years

“…The prevalence of chromosomal and structural abnormalities in our cohort is similar to that published so far [19][20][21][22][23][24][25] . We have to underline that urethral pathology is different according to gestational age.…”

Epidemiology and demography of recently diagnosed cases of posterior urethral valves

“…Anumba et al examined cases reported to a Northern Congenital Abnormality Survey between 1984 and 1997 and estimated the incidence of PUV at 1.4 per 10,000 births (1 in 7,100) (5). A recent retrospective study with similar methods, using data collected over 12 y in the Western Midlands region found 179 cases of PUV in 851,419 births (63% of all LUTO cases), including all registered births, terminations of pregnancy and spontaneous fetal losses (7). The birth prevalence of PUV was therefore 2.1/10,000 (SD = 1.79-2.41).…”

“…The aims of this two-part study were firstly to determine the incidence of PUV in an Australian population and further, to test the hypothesis proposed by Malin et al (7), that socioeconomic factors were associated with the occurrence of PUV.…”

Avances en terapia fetal

“…[56][57] Se han ideado numerosos procedimientos como las vesicocentesis seriadas y la colocación de catéter vésico-amniótico para disminuir los efectos de la obstrucción intra-útero. Una revisión sistemática de la literatura 56 no solo no pudo demostrar ningún beneficio a favor de la intervención prenatal para preservar la función renal sino que, de hecho, las posibilidades de supervivencia con función renal normal podrían estar disminuidas.…”