In utero intervention for urologic diseases.
Douglass B Clayton1, John W Brock
1Department of Urologic Surgery, Division of Pediatric Urology, Vanderbilt University, 2200 Children's Way, Suite 4102, Nashville, TN 37232-9820, USA. douglass.b.clayton@ vanderbilt.edu
Nature Reviews. Urology
|February 22, 2012
Summary
Prenatal intervention shows promise for fetal urologic disorders like congenital adrenal hyperplasia and lower urinary tract obstruction. Fetal myelomeningocele repair significantly reduced hydrocephalus, highlighting the need for better outcome studies in fetal urology.
Area of Science:
- Urology
- Maternal-Fetal Medicine
- Developmental Biology
Background:
- Prenatal ultrasonography enables early diagnosis of fetal urologic anomalies.
- Fetal intervention is emerging as a therapeutic option for select conditions.
- Congenital adrenal hyperplasia (CAH), lower urinary tract obstruction (LUTO), and myelomeningocele are key targets.
Purpose of the Study:
- To review the current state and future directions of fetal intervention for urologic disorders.
- To assess the efficacy and limitations of interventions for CAH, LUTO, and myelomeningocele.
- To identify areas for improvement in studying clinical outcomes.
Main Methods:
- Review of existing literature on fetal interventions for CAH, LUTO, and myelomeningocele.
- Analysis of outcomes from surgical and pharmacological treatments.
- Evaluation of evidence from systematic reviews and randomized controlled trials.
Main Results:
- In utero treatment of CAH with glucocorticoids shows success, but long-term effects are unknown.
- Vesicoamniotic shunting for LUTO improves perinatal survival, based on limited data.
- Fetal myelomeningocele repair in a randomized trial significantly decreased hydrocephalus and shunt placement.
Conclusions:
- Fetal intervention offers potential benefits for specific urologic conditions.
- Further research, particularly prospective randomized trials, is crucial for establishing optimal treatment protocols.
- Improved methodologies for outcome assessment are essential for advancing fetal urology.
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