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Elizabeth A Enninga, Rodrigo Ruano
Fetal lower urinary tract obstruction (LUTO) is a heterogeneous pathology associated with a high morbidity and mortality due to pulmonary hypoplasia. Previously, when a fetus was diagnosed on ultrasound with LUTO, expectant care or termination was the only option; this has changed because of fetal surgical intervention. Vesicoamniotic shunts and cystoscopy are the current methods utilized to treat LUTO; however, it remains difficult to determine whether or not fetal prognosis favors intervention and long term outcome follow up has been limited...
November 21, 2017: Minerva Pediatrica
Rodrigo Ruano, Timothy Dunn, Michael C Braun, Joseph R Angelo, Adnan Safdar
The authors present an overview of lower urinary tract obstruction (LUTO) in the fetus with a particular focus on the insult to the developing renal system. Diagnostic criteria along with the challenges in estimating long-term prognosis are reviewed. A proposed prenatal LUTO disease severity classification to guide management decisions with fetal intervention to maintain or salvage in utero and neonatal pulmonary and renal function is also discussed. Stage I LUTO (mild form) is characterized by normal amniotic fluid index after 18 weeks, normal kidney echogenicity, no renal cortical cysts, no evidence of renal dysplasia, and favorable urinary biochemistries when sampled between 18 and 30 weeks; prenatal surveillance is recommended...
July 21, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
M K Farrugia, M C Braun, C A Peters, R Ruano, C D Herndon
INTRODUCTION: The Society for Fetal Urology panel section at the 2016 Fall Congress featured a multidisciplinary discussion on appropriate patient selection, the conservative versus surgical management, and postnatal renal outcome of fetuses with lower urinary tract obstruction (LUTO). SELECTION CRITERIA FOR INTERVENTION: Rodrigo Ruano shared his experience of prenatal intervention, presenting the outcome of 111 fetuses with severe LUTO treated with vesicoamniotic shunting (VAS) (n = 16), cystoscopy (n = 34) or no intervention (n = 61) in a non-randomized series...
August 2017: Journal of Pediatric Urology
Shilpa Sharma, Ranjana Bhanot, Dipika Deka, Minu Bajpai, Devendra K Gupta
AIM: To analyze the impact of counseling on antenatal congenital surgical anomalies (ACSA). METHODS: Cases presenting with ACSA for fetal counseling and those presenting in post-natal period following diagnosis of ACSA (PACSA) for surgical opinion were analyzed for spectrum, presentation and outcome. RESULTS: 117 cases including ACSA(68);PACSA(49) were analyzed. Gestational age at diagnosis of ACSA;PACSA was 17-37;17-39 weeks (median 24;32 weeks)...
February 2017: Pediatric Surgery International
Andrew H Chon, Gustavo H de Oliveira, Kevin V Lemley, Lisa M Korst, Ryan D Assaf, Ramen H Chmait
INTRODUCTION: Although mortality has decreased for fetuses with lower urinary tract obstruction treated with vesicoamniotic shunt (VAS) placement, survivors remain at risk for long-term renal impairment. We tested the association of fetal serum β2-microglobulin (fsβ2M) with postnatal renal function in these patients, hypothesizing that fsβ2M may predict such renal impairment. MATERIALS AND METHODS: fsβ2M was obtained in patients undergoing VAS placement. The primary outcome was renal function at 3-12 months of life, as assessed by a pediatric nephrologist using medical records...
2017: Fetal Diagnosis and Therapy
R Stadié, B Strizek, I Gottschalk, A Geipel, U Gembruch, C Berg
OBJECTIVE: To examine the outcome of fetuses with megacystis treated with vesicoamniotic shunting (VAS) from 14 weeks onward. METHODS: Retrospective review of all fetuses that received VAS at two centres from 2004 to 2012. RESULTS: 53 fetuses with megacystis were included in the study. Mean gestational age at diagnosis was 16.4 weeks. Mean gestational age at first shunt placement was 17.8 weeks. The first shunt placement was performed before 16 weeks in 18 (34 %) cases...
November 2016: Archives of Gynecology and Obstetrics
Venu Jain, Sujata Chandra, Darcie A Kiddoo
No abstract text is available yet for this article.
April 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Sina Haeri, David H Simon, Kartik Pillutla
Fetal lower urinary tract obstruction (LUTO) encompasses a heterogeneous group of congenital pathologies and generally results in oligohydramnios. Fetal intervention (e.g. vesicoamniotic shunting, fetal cystoscopy) has traditionally been reserved for cases with a favorable renal profile, while those with unfavorable renal function have been offered termination or expectant management with the latter leading to high incidence of marked pulmonary hypoplasia, neonatal morbidity and mortality. Here, we describe two cases, which were not candidates for traditional intervention based on abnormal fetal renal function, who elected to proceed with serial amnioinfusions for fetal pulmonary palliation to attenuate the risk of pulmonary hypoplasia...
January 2017: Journal of Maternal-fetal & Neonatal Medicine
R Ruano, N Sananes, C Wilson, J Au, C J Koh, P Gargollo, A A Shamshirsaz, J Espinoza, A Safdar, A Moaddab, N Meyer, D L Cass, O O Olutoye, O A Olutoye, S Welty, D R Roth, M C Braun, M A Belfort
OBJECTIVE: To present a single center experience of a standardized prenatal multidisciplinary management protocol for fetal lower urinary tract obstruction (LUTO) and to propose a classification of fetal LUTO based on disease severity. METHODS: This was a retrospective cohort study of 25 consecutive fetal patients with prenatal diagnosis of primary LUTO. Fetal intervention was offered after evaluation by a multidisciplinary team. Analyses were conducted using Bayesian methodology to determine predictors of survival at 6 months postpartum...
October 2016: Ultrasound in Obstetrics & Gynecology
M O Akkurt, A Yavuz, M Sezik, M O Ozkaya
No abstract text is available yet for this article.
2016: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
Paolo Sala, Federico Prefumo, Daniela Pastorino, Davide Buffi, Chiara Roberta Gaggero, Marilena Foppiano, Pierangela De Biasio
In utero fetal surgery interventions are currently considered in selected cases of congenital diaphragmatic hernia, cystic pulmonary abnormalities, amniotic band sequence, selected congenital heart abnormalities, myelomeningocele, sacrococcygeal teratoma, obstructive uropathy, and complications of twin pregnancy. Randomized controlled trials have demonstrated an advantage for open fetal surgery of myelomeningocele and for fetoscopic selective laser coagulation of placental vessels in twin-to-twin transfusion syndrome...
April 2014: Obstetrical & Gynecological Survey
Rk Morris, Lj Middleton, Gl Malin, E Quinlan-Jones, Jp Daniels, Ks Khan, Jj Deeks, Md Kilby
OBJECTIVE: Describe the influences on decision making in fetal lower urinary tract obstruction (LUTO) and identify prenatal prognostic features. METHODS: The PLUTO study included a registry of cases of isolated LUTO with conservative management or vesicoamniotic shunting (VAS). Logistic regression analysis examined prognostic features affecting outcome. For comparison of effectiveness the outcomes were survival to 2 years and renal function. RESULTS: 45 women were registered, 78% (35/45) received conservative management...
June 2014: Archives of Disease in Childhood. Fetal and Neonatal Edition
Anne-Claude Müller Brochut, Daniel Thomann, Wolfram Kluwe, Edoardo Di Naro, Anette Kuhn, Luigi Raio
OBJECTIVES: Megacystis (MC) is rare and often associated with other structural and chromosomal anomalies. In euploid cases with early oligohydramnios, prognosis is poor mainly due to pulmonary hypoplasia and renal damage. We report our experience of the past 20 years. METHODS: A retrospective review of cases with prenatally diagnosed MC was performed. Complete prenatal as well as postnatal medical records from 1989 to 2009 were reviewed focusing on diagnostic precision, fetal interventions [vesicocentesis (VC), vesicoamniotic shunt (VAS)], short- and long-term outcome, and potential prognostic factors...
2014: Fetal Diagnosis and Therapy
Mark D Kilby, R Katie Morris
Lower urinary tract obstruction (LUTO) comprises a heterogeneous group of pathologies associated with early-onset oligohydramnios and cystic renal disease that have high rates of perinatal morbidity (from renal disease) and mortality (from pulmonary hypoplasia). The use of prenatal detailed ultrasonography and fetal urine analysis has been only partially successful in identifying fetuses with LUTO with relatively good prognosis that would benefit from in utero therapy. The most common prenatal therapy is vesicoamniotic shunting...
July 2014: Nature Reviews. Urology
Lea Tuzovic, Kwame Anyane-Yeboa, Ashley Mills, Kenneth Glassberg, Russell Miller
OBJECTIVE: To investigate prenatal ultrasonographic findings associated with megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS). METHODS: A PubMed search was performed using the terms 'MMIHS', 'MMIH' and 'prenatal diagnosis'. RESULTS: A total of 50 cases were analyzed. Prenatal diagnosis was achieved in 26% of cases. In 54% of patients with a correct antenatal diagnosis there was a previously affected sibling. Fetal megacystis with or without hydroureteronephrosis was the most common initial ultrasonographic finding (88%)...
2014: Fetal Diagnosis and Therapy
R Ruano, C T Yoshizaki, A M Giron, M Srougi, M Zugaib
We report the case of a fetus with severe megabladder, displaying the 'keyhole' sign on ultrasound imaging, that underwent cystoscopy at 22 weeks' gestation. There was a familial history of mild urethral atresia. Fetal cystoscopy revealed congenital urethral atresia. A guide wire was advanced through the fetal urethra and a transurethral vesicoamniotic stent was placed successfully. The fetus was delivered at 36 weeks' gestation and postnatal cystoscopy confirmed the absence of posterior urethral valves or urethral atresia...
August 2014: Ultrasound in Obstetrics & Gynecology
R K Morris, G L Malin, E Quinlan-Jones, L J Middleton, L Diwakar, K Hemming, D Burke, J Daniels, E Denny, P Barton, T E Roberts, K S Khan, J J Deeks, M D Kilby
BACKGROUND: Congenital lower urinary tract obstruction (LUTO) is a disease associated with high perinatal mortality and childhood morbidity. Fetal vesicoamniotic shunting (VAS) bypasses the obstruction with the potential to improve outcome. OBJECTIVE: To determine the effectiveness, cost-effectiveness and patient acceptability of VAS for fetal LUTO. DESIGN: A multicentre, randomised controlled trial incorporating a prospective registry, decision-analytic health economic model and preplanned Bayesian analysis using elicited opinions...
December 2013: Health Technology Assessment: HTA
Douglass B Clayton, John W Brock
No abstract text is available yet for this article.
November 2013: Nature Reviews. Urology
Rachel K Morris, Gemma L Malin, Elisabeth Quinlan-Jones, Lee J Middleton, Karla Hemming, Danielle Burke, Jane P Daniels, Khalid S Khan, Jon Deeks, Mark D Kilby
BACKGROUND: Fetal lower urinary tract obstruction (LUTO) is associated with high perinatal and long-term childhood mortality and morbidity. We aimed to assess the effectiveness of vesicoamniotic shunting for treatment of LUTO. METHODS: In a randomised trial in the UK, Ireland, and the Netherlands, women whose pregnancies with a male fetus were complicated by isolated LUTO were randomly assigned by a central telephone and web-based randomisation service to receive either the intervention (placement of vesicoamniotic shunt) or conservative management...
November 2, 2013: Lancet
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