Outcomes of fetuses with lower urinary tract obstruction treated with vesicoamniotic shunt: A single-institution experience

Cecilia G. Ethun, Irving J. Zamora, David R. Roth, Arundhati S Kale, Lars Cisek, Michael A. Belfort, Sina Haeri, Rodrigo Ruano, Stephen E. Welty, Christopher I. Cassady, Oluyinka O. Olutoye, Darrell L. Cass

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

AbstractPurpose The purpose of this manuscript was to examine the outcomes of patients with lower urinary tract obstruction (LUTO) treated with vesicoamniotic shunt (VAS) to improve the quality of prenatal consultation and therapy. Methods The medical records of all patients diagnosed with LUTO at our center between January 2004 and March 2012 were reviewed retrospectively. Results Of 14 male fetuses with LUTO, all with characteristic ultrasound findings, 11 underwent intervention. One patient received vesicocentesis alone, while 10 had VAS. Two fetuses additionally underwent cystoscopy (one with attempted valve ablation), and two had peritoneoamniotic shunts. Of 16 total VAS, 13 were placed successfully, 8 dislodged (median 7 days), and 1 obstructed (84 days). Two fetuses suffered in utero demise, and two have unknown outcomes. LUTO was confirmed in six of eight live-born fetuses. One patient died in the neonatal period, while seven survived. All six available at follow-up (median 3.7 years), had significant genitourinary morbidity. Five patients had chronic kidney disease, but only one has required dialysis and transplant. Three had respiratory insufficiency, and one required a tracheostomy. Conclusion Despite significant perinatal and long-term morbidity, VAS offers patients faced with a poor prognosis an improved chance of survival. Our results underscore the need for further research into the diagnosis and treatment of LUTO.

Original languageEnglish (US)
Pages (from-to)956-962
Number of pages7
JournalJournal of Pediatric Surgery
Volume48
Issue number5
DOIs
StatePublished - May 1 2013
Externally publishedYes

Keywords

  • Fetal surgery
  • LUTO
  • Prenatal diagnosis
  • Prune belly syndrome
  • Vesicoamniotic shunt

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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    Ethun, C. G., Zamora, I. J., Roth, D. R., Kale, A. S., Cisek, L., Belfort, M. A., Haeri, S., Ruano, R., Welty, S. E., Cassady, C. I., Olutoye, O. O., & Cass, D. L. (2013). Outcomes of fetuses with lower urinary tract obstruction treated with vesicoamniotic shunt: A single-institution experience. Journal of Pediatric Surgery, 48(5), 956-962. https://doi.org/10.1016/j.jpedsurg.2013.02.011