In utero therapy for lower urinary tract obstruction.

Area of Science:

• Neonatal medicine
• Pediatric surgery
• Fetal medicine

Background:

• Lower urinary tract obstruction (LUTO) significantly impacts neonatal and child health, potentially causing pulmonary hyperplasia and renal impairment.
• Accurate diagnosis and prognosis assessment are crucial for managing LUTO, with ultrasound and urinary analysis being key evaluation tools.

Purpose of the Study:

• To review the evaluation, case selection, and therapeutic options for fetal lower urinary tract obstruction.
• To discuss the efficacy and limitations of current fetal intervention strategies.

Main Methods:

• Review of current literature on fetal lower urinary tract obstruction and its management.
• Analysis of diagnostic tools including ultrasound and urinary analysis.
• Evaluation of fetal intervention modalities: vesico-amniotic shunting, open fetal surgery, and endoscopic fetal surgery.

Main Results:

• Fetal intervention decisions require careful case selection to balance potential benefits against risks of intervention and procedure-related complications.
• Vesico-amniotic shunting can bypass obstruction but carries complications; open fetal surgery is generally not recommended due to high fetal loss.
• Fetal endoscopic surgery is an emerging technique with limited current application but potential for future treatment of LUTO.

Conclusions:

• Optimal management of fetal lower urinary tract obstruction hinges on precise evaluation, judicious case selection, and consideration of available, albeit limited, therapeutic options.
• Further research is needed to establish the efficacy of various fetal interventions and refine techniques, particularly for endoscopic approaches.