Related Experiment Video
Updated: Feb 1, 2026
Assessing Urinary Tract Junction Obstruction Defects by Methylene Blue Dye Injection
Published on: October 12, 2017
Antenatal intervention for congenital fetal lower urinary tract obstruction (LUTO): a systematic review and
Gabriele Saccone1, Pietro D'Alessandro1, Maria Escolino1
1Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II", Naples, Italy.
Insights
Antenatal intervention, such as bladder drainage for congenital lower urinary tract obstruction (LUTO), significantly improves perinatal survival rates. This treatment also shows promise for enhancing postnatal renal function in affected fetuses.
Area of Science:
- Perinatology
- Fetal Surgery
- Pediatric Urology
Background:
- Congenital lower urinary tract obstruction (LUTO) poses significant risks to fetal development and survival.
- Effective management strategies for LUTO are crucial for improving perinatal outcomes.
Purpose of the Study:
- To evaluate the effectiveness of antenatal intervention for congenital LUTO.
- To assess the impact of these interventions on perinatal survival and postnatal renal function.
Main Methods:
- A meta-analysis of randomized controlled trials and nonrandomized studies was conducted.
- Studies included fetuses with ultrasound-diagnosed LUTO undergoing antenatal bladder drainage.
- Primary outcomes were perinatal survival and postnatal renal function.
Main Results:
- Antenatal bladder drainage, particularly vesico-amniotic shunting, was associated with improved perinatal survival (OR: 2.54).
- Survival rates were 57.1% with shunting versus 38.8% in the conservative group.
- Fetal cystoscopy also showed improved perinatal survival (OR: 2.63) and better postnatal renal function (OR: 1.75).
Conclusions:
- Antenatal bladder drainage is an effective intervention for congenital LUTO.
- These interventions appear to enhance both survival and renal function in affected neonates.
Abstract:
Objective: To evaluate the effectiveness of antenatal intervention for the treatment of congenital lower urinary tract obstruction (LUTO) in improving perinatal survival and postnatal renal function.Methods: Electronic databases were searched from their inception until May 2018. Selection criteria included randomized controlled trials and nonrandomized studies including fetuses with ultrasound evidence of LUTO evaluating antenatal intervention for improving perinatal outcomes. Any type of antenatal bladder drainage technique was analyzed. The primary outcome was perinatal survival. The secondary outcome was postnatal survival with normal renal function. The summary measures were reported as summary odds ratio (OR) with 95% of confidence interval (CI).Results: Ten articles with a total of 355 fetuses were included in the meta-analysis. Inclusion criteria of the selected studies were singleton pregnancy with severe LUTO confirmed on detailed fetal ultrasound examination. Nine studies analyzed the efficacy of vesico-amniotic shunt performed in the second trimester. The overall estimate survival was higher in the vesico-amniotic shunt group compared to the conservative group (OR: 2.54, 95% CI: 1.14-5.67). 64/112 fetuses (57.1%) survived in the vesico-amniotic shunt group compared to 52/134 (38.8%) in the control group. Five studies reported on postnatal renal function between 6 months and 2 years. Rate of good postnatal renal function was higher in the vesico-amniotic shunt group compared to the conservative group (OR: 2.09, 95% CI: 0.74-5.9). Fetal cystoscopy was performed in only two included studies. Overall, 45 fetuses underwent fetal cystoscopy. The perinatal survival was higher in the cystoscopy group compared to the conservative management group (OR: 2.63, 95% CI: 1.07-6.47). Normal renal function was noted in 13/34 fetuses in the cystoscopy group versus 12/61 in the conservative management group at 6 months follow-up (OR: 1.75, 95% CI: 1.05-2.92)Conclusions: Antenatal bladder drainage appears to improve perinatal survival in cases of LUTO.
Related Concept Videos
01:28Urinary Tract Calculi I: Introduction
01:26Urinary Tract Infection I: Introduction
01:25Urinary Tract Infection II: Pathophysiology
01:28Urinary Tract Calculi V: Nursing Management
01:25Urinary Tract Calculi VI: Surgical Management
01:17Urinary Tract Infection IV: Nursing Management