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Follow-up of children after fetal treatment for obstructive uropathy
K Shimada1, S Hosokawa, A Tohda
1Division of Urology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan.
Insights
Fetal shunt placement for obstructive uropathy can improve renal and pulmonary function if done before 20 weeks gestation. However, its impact on developing functional bladder capacity remains uncertain.
Area of Science:
- Pediatric Urology
- Fetal Medicine
- Neonatal Care
Background:
- Advances in fetal evaluation and treatment have enabled successful prenatal intervention for obstructive uropathy.
- This study analyzes the clinical outcomes of fetuses treated with in utero shunt placement.
Purpose of the Study:
- To evaluate the prenatal and postnatal clinical courses of infants who underwent fetal intervention for obstructive uropathy.
- To assess the effectiveness of in utero shunt placement on renal, pulmonary, and bladder function.
Main Methods:
- Retrospective analysis of 6 patients who underwent fetal intervention for urologic conditions.
- Gestational age at detection ranged from 11 to 31 weeks; intervention occurred between 16 and 32 weeks.
- Follow-up included assessment of renal function (serum creatinine) and bladder management.
Main Results:
- Urologic pathologies included prune belly syndrome, cloacal anomaly, posterior urethral valves, and pelviureteric junction stenosis.
- Four patients required neonatal ventilation; 2 experienced recurrent infections.
- Five patients require ongoing clean intermittent catheterization due to impaired bladder function post-shunt placement.
Conclusions:
- Early fetal shunt placement (before 20 weeks gestation) may positively impact renal and pulmonary development in cases of severe lower urinary tract obstruction.
- The efficacy of fetal shunt placement in promoting functional bladder development is questionable, as it may not support regular storage and evacuation.
Background:
Improvement in the ability to evaluate fetuses with obstructive uropathy, combined with technologic advances, has allowed successful fetal treatment of these conditions in Japan. We analyzed the prenatal and postnatal clinical courses of patients who underwent shunt placement in utero.
Methods:
We treated 6 patients who underwent fetal intervention and were transferred to us for urologic management. Gestational age at detection of abnormalities ranged from 11 weeks to 31 weeks, and fetal intervention was done between 16 weeks and 32 weeks. Excluding 1 infant who was delivered 6 days after the intervention, the mean period between shunt placement and delivery was 17 weeks.
Results:
Urologic pathology included prune belly syndrome with urethral hypoplasia in 3 patients, cloacal anomaly in 1, posterior urethral valves in 1, and pelviureteric junction stenosis of a solitary kidney in 1. Four patients required ventilation support in the neonatal period, and 2 of them suffered frequent infections during follow-up. Five patients who underwent vesico-amniotic shunt placement continue to require clean intermittent catheterizations via vesicostomy because of hypoactive detrusors and hypoplastic urethras. After urologic treatment, serum creatinine in 5 patients reached a minimum of less than 0.4 mg/dL at some time during the first year of life. Another patient with a minimum creatinine level of 1.0 mg/dL has moderate renal insufficiency.
Conclusion:
From our series, it appears that early (before 20 weeks of gestation) shunt placement in severe lower urinary tract obstruction may benefit renal and pulmonary function. However, its efficacy in regard to bladder function remains questionable: shunt placement does not permit regular storage and evacuation, which may be essential for functional bladder development.