Assessing candidacy for fetal intervention in congenital lower urinary tract obstruction: A comprehensive review

Congenital Lower Urinary Tract Obstruction (LUTO) is a rare but severe fetal condition, affecting approximately 2.2 per 10,000 live births. It is associated with complications such as oligohydramnios, pulmonary hypoplasia, and renal dysfunction. Prenatal interventions offer potential benefits in improving perinatal survival, however, selecting the most suitable candidates for interventions has been a challenge. Recent research emphasizes the evaluation of LUTO patients with a multidisciplinary approach. Criteria for fetal intervention were established in an international Delphi consensus, and includes imaging findings indicative of LUTO, the absence of life-limiting structural or genetic anomalies, gestational age ≥16 weeks, and the presence of oligohydramnios. Although bladder refill and fetal urine biochemistry may provide additional insights into prognosis and counseling, their precise role in candidate selection remains uncertain. Future research should focus on developing more reliable biomarkers to enhance the evaluation of LUTO and assess renal function.