Outcomes of fetuses with lower urinary tract obstruction treated with vesicoamniotic shunt: a single-institution experience

J Pediatr Surg. 2013 May;48(5):956-62. doi: 10.1016/j.jpedsurg.2013.02.011.


Purpose: The purpose of this manuscript was to examine the outcomes of patients with lower urinary tract obstruction (LUTO) treated with vesicoamniotic shunt (VAS) to improve the quality of prenatal consultation and therapy.

Methods: The medical records of all patients diagnosed with LUTO at our center between January 2004 and March 2012 were reviewed retrospectively.

Results: Of 14 male fetuses with LUTO, all with characteristic ultrasound findings, 11 underwent intervention. One patient received vesicocentesis alone, while 10 had VAS. Two fetuses additionally underwent cystoscopy (one with attempted valve ablation), and two had peritoneoamniotic shunts. Of 16 total VAS, 13 were placed successfully, 8 dislodged (median 7 days), and 1 obstructed (84 days). Two fetuses suffered in utero demise, and two have unknown outcomes. LUTO was confirmed in six of eight live-born fetuses. One patient died in the neonatal period, while seven survived. All six available at follow-up (median 3.7 years), had significant genitourinary morbidity. Five patients had chronic kidney disease, but only one has required dialysis and transplant. Three had respiratory insufficiency, and one required a tracheostomy.

Conclusion: Despite significant perinatal and long-term morbidity, VAS offers patients faced with a poor prognosis an improved chance of survival. Our results underscore the need for further research into the diagnosis and treatment of LUTO.

MeSH terms

  • Abnormalities, Multiple / epidemiology
  • Abortion, Induced
  • Amniotic Fluid*
  • Anastomosis, Surgical
  • Dilatation, Pathologic / diagnostic imaging
  • Dilatation, Pathologic / embryology
  • Dilatation, Pathologic / surgery
  • Female
  • Fetal Diseases / diagnostic imaging
  • Fetal Diseases / surgery*
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / surgery
  • Male
  • Oligohydramnios / etiology
  • Postoperative Complications / epidemiology
  • Postoperative Complications / surgery
  • Pregnancy
  • Pregnancy Outcome
  • Respiratory Distress Syndrome, Newborn / epidemiology
  • Stillbirth / epidemiology
  • Surgical Instruments
  • Treatment Outcome
  • Ultrasonography, Interventional
  • Ultrasonography, Prenatal
  • Urethral Obstruction / diagnostic imaging
  • Urethral Obstruction / embryology
  • Urethral Obstruction / surgery*
  • Urinary Bladder / embryology
  • Urinary Bladder / surgery*
  • Urinary Bladder Neck Obstruction / diagnostic imaging
  • Urinary Bladder Neck Obstruction / embryology
  • Urinary Bladder Neck Obstruction / surgery*

Supplementary concepts

  • Respiratory Distress Syndrome In Premature Infants