Congenital urinary tract obstruction

Abstract

Congenital urinary tract obstruction is a heterogenous condition with a varying natural history. Accurate diagnosis within the late-first and second trimesters allows for counselling of the parents and planning of multi-disciplinary care for the pregnancy and newborn. Antenatal investigations to predict postnatal renal function are of varying accuracy. However, some factors have been shown to be predictive of poor outcome in terms of renal function at birth and infancy. There is the possibility of in-utero intervention in these fetuses.

The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis

“…Although this paper suffered from selection bias, it appears that patients with bladder outlet obstruction benefited from targeted prenatal intervention. For further discussions on management and controversies in fetal intervention, refer to recent reviews by Wu and Johnson [93], Thomas [94], Morris and Kilby [95], and Yiee and Wilcox [96].…”

Prenatal diagnosis of LUTO: improving diagnostic accuracy

“…This typically starts with evidence of a distended bladder (megacystis) accompanied by hydronephrosis, progressing to renal dysplasia with abnormal renal parenchymal appearance on ultrasound examination and eventually resulting in severe oligohydramnios. The condition is associated with a high rate of mortality and postnatal morbidity due to lung hypoplasia and impaired renal function. When LUTO is suspected in the first trimester and megacystis >12 mm is seen, the prognosis is extremely poor and parents often opt for termination of pregnancy.…”

Advances in fetal therapy

“… Forest plot showing summary of effects of prenatal bladder drainage, using summary odds ratio, on perinatal and postnatal survival in fetuses with ultrasound evidence of lower urinary tract obstruction (analysis corrected for voluntary pregnancy terminations) 59 . Copyright 2009, with permission from Elsevier …”