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Long-term outcome in children after antenatal intervention for obstructive uropathies
A L Freedman1, M P Johnson, C A Smith
1Department of Paediatric Urology, Children's Hospital of Michigan, Detroit, USA.
Insights
Antenatal intervention for fetal obstructive uropathy shows promising long-term outcomes. Vesicoamniotic shunt placement can improve results for severe cases, offering results comparable to less severe conditions.
Area of Science:
- Pediatric Urology
- Fetal Surgery
- Neonatal Care
Background:
- Antenatal intervention for fetal obstructive uropathy has been performed for over a decade.
- Long-term outcomes following fetal intervention remain largely unknown.
- Assessing long-term implications of fetal intervention is crucial for guiding clinical practice.
Purpose of the Study:
- To evaluate the long-term outcomes of children who underwent vesicoamniotic shunt placement for fetal obstructive uropathy.
- To understand the implications of antenatal intervention on growth, renal function, and continence.
Main Methods:
- Retrospective review of clinical outcomes for 14 children who underwent vesicoamniotic shunt placement.
- Follow-up assessment of children who survived beyond 2 years of age.
- Analysis of diagnoses, growth parameters, renal function, and urinary continence.
Main Results:
- Of 34 patients who underwent shunt placement, 21 survived beyond 2 years. Mean follow-up was 54.3 months.
- Common diagnoses included prune belly syndrome (7) and posterior urethral valves (4).
- Significant findings included short stature (86% below 25th percentile), renal failure/transplantation (36%), renal insufficiency (21%), and varying degrees of urinary continence (50% continent).
Conclusions:
- Antenatal intervention with vesicoamniotic shunts may benefit fetuses with severe obstructive uropathy, potentially averting a fatal neonatal course.
- The outcomes achieved are comparable to less severe cases typically diagnosed postnatally.
- This intervention offers a viable option for improving long-term outcomes in selected fetal obstructive uropathy cases.
Background:
Antenatal intervention has been done for fetal obstructive uropathy for over a decade, yet little is known about long-term outcomes. To assess the long-term implications of fetal intervention, we reviewed the outcomes of children who underwent vesicoamniotic shunt placement.
Methods:
We reviewed the clinical outcomes of 14 children who underwent vesicoamniotic shunt placement at our institution and who survived beyond 2 years of age.
Findings:
In 1987-96, 34 patients underwent vesicoamniotic shunt placement. 13 died and 21 survived, of whom 17 are now more than 2 years old. Three survivors were lost to follow-up. Mean age at follow-up was 54.3 months (range 25-114). Final diagnoses included prune belly syndrome (seven cases), posterior urethral valves (four), urethral atresia (one), vesicoureteral reflux (one), and megacystis (one). Height was below the 25th percentile in 12 (86%) with seven (50%) below the 5th percentile. Five (36%) had renal failure and had successful transplantation, three (21%) have renal insufficiency, and six (43%) have normal renal function. Seven (50%) are acceptably continent, five (36%) have not yet begun toilet-training, and two (14%) are incontinent. Three of four children with valves needed bladder augmentation.
Interpretation:
Antenatal intervention may help those fetuses with the most severe forms of obstructive uropathy, usually associated with a fatal neonatal course. Intervention achieves outcomes similar to less severe cases that are usually diagnosed postnatally.
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