Implementation of a standardized clinical pathway in a dedicated posterior urethral valves clinic: short-term outcomes

Rickard, Mandy; Lorenzo, Armando J.; Richter, Juliane; Brownrigg, Natasha; Kim, Jin K.; Chua, Michael; Goraya, Noreen; Khondker, Adree; Yadav, Priyank; Keefe, Daniel T.; Shinar, Shiri; Dos Santos, Joana

doi:10.1007/s00467-023-06040-7

Cited by 10 publications

(2 citation statements)

References 40 publications

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“…Ultrasound should be done as early as possible to assess the kidneys and bladder. 48 Importantly, it should be noted that the presence of a urinary stream or "spontaneous voiding" does not rule out LUTO. Infants with suspected LUTO require urgent bladder decompression and some may need respiratory support due to pulmonary hypoplasia.…”

Section: Lower Urinary Tract Obstructionmentioning

confidence: 99%

“…Infants with suspected LUTO should be born in a high‐risk tertiary center because of the need for early neonatal interventions and assessment by pediatric urology and nephrology teams. Ultrasound should be done as early as possible to assess the kidneys and bladder 48 . Importantly, it should be noted that the presence of a urinary stream or “spontaneous voiding” does not rule out LUTO.…”

Section: Postnatal Management and Natural Historymentioning

confidence: 99%

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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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Section: Lower Urinary Tract Obstructionmentioning

confidence: 99%

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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Use of prenatal ultrasound findings to predict postnatal outcome in fetuses with lower urinary tract obstruction

Richter,

Shinar,

Erdman

et al. 2024

Ultrasound in Obstet & Gyne

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ObjectiveLower urinary tract obstruction (LUTO) is a chronic condition with a spectrum of outcomes. It is usually suspected prenatally based on ultrasound features (USFs). Given the unknown postnatal trajectory and the potential for significant morbidity and mortality, many families choose termination of pregnancy (TOP), often based on USFs alone. Herein, we sought to develop a tool that can be used to predict postnatal outcome based on combinations of USFs, which can aid prenatal counseling and parental decision‐making.MethodsThis was a retrospective study of cases with suspected fetal LUTO that were seen at a high‐risk fetal center and a tertiary pediatric center in Canada. Data were collected on USFs, prenatal/postnatal death and postnatal need for transplantation and/or dialysis. USFs from pregnancies with a gestational age of 13–26 weeks on initial ultrasound at the high‐risk fetal center that underwent TOP were collected and matched to fetuses with comparable prenatal USFs that were not terminated, which had a known postnatal outcome, to build a random forest model. The random forest model was fitted for each outcome (death, dialysis or transplantation) and tested for accuracy using leave‐one‐out cross‐validation. Each predictor was assessed independently with combined importance when accounting for other predictors. The model was used to predict the most likely postnatal outcomes for cases of TOP had the pregnancy been continued.ResultsUSF data from 85 cases of TOP and 125 cases of expectantly managed pregnancy with prenatally suspected LUTO were retrieved. For expectantly managed cases, there was a median follow‐up duration of 5.7 (interquartile range, 0.2–14.5) years among the liveborn infants. There were 14 prenatal and 22 postnatal deaths in the expectantly managed cohort. The random forest model demonstrated the highest predictive accuracy for transplantation (77% accuracy, 50% sensitivity, 80% specificity), followed by death (72% accuracy, 83% sensitivity, 67% specificity) and dialysis (71% accuracy, 70% sensitivity, 71% specificity). For the TOP cohort, had the pregnancies been continued, the model predicted transplantation and dialysis in 21/85 (25%) and 37/85 (44%) cases, respectively; pre‐ or postnatal death was predicted in 69/85 (81%) cases.ConclusionsOur data suggest that it is possible to predict death and postnatal transplantation and/or dialysis from USFs in fetuses with suspected LUTO with acceptable accuracy. Predictive accuracy will improve with continued follow‐up of more patients, enabling more personalized prenatal counseling and more informed decision‐making for families. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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Is posterior urethral valve a chronic disease, not merely a chronic kidney disease? Reflections on models of (multidisciplinary) care

Deshpande

2023

Pediatr Nephrol

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Implementation of a standardized clinical pathway in a dedicated posterior urethral valves clinic: short-term outcomes

Cited by 10 publications

References 40 publications

Fetal urinary tract dilation: What to tell the parents

Fetal urinary tract dilation: What to tell the parents

Use of prenatal ultrasound findings to predict postnatal outcome in fetuses with lower urinary tract obstruction

Is posterior urethral valve a chronic disease, not merely a chronic kidney disease? Reflections on models of (multidisciplinary) care

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