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MINERVA PEDIATRICA

A Journal on Pediatrics, Neonatology, Adolescent Medicine,
Child and Adolescent Psychiatry


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Minerva Pediatrica 2017 Nov 21

DOI: 10.23736/S0026-4946.17.05105-2

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Fetal surgery for lower urinary tract obstruction: the importance of staging prior to intervention

Elizabeth A. ENNINGA, Rodrigo RUANO

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA


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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. This review covers the history and current challenges of fetal intervention for obstructive uropathies. We also present the Ruano’s LUTO staging system which integrates information from fetal urine analysis with ultrasound findings to assess whether a specific fetal intervention is recommended. Utilizing a standard staging system that is readily adopted by providers carrying out fetal surgery is crucial for determining the true impact on outcomes intervention has on fetuses diagnosed with LUTO.


KEY WORDS: Lower urinary tract obstruction - Oligohydramnios - Obstructive uropathies - Vesicoamniotic shunt - Fetal cystoscopy - Bladder outlet obstruction - Fetal surgery - Prenatal diagnosis - Ultrasound

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Publication History

Article first published online: November 20, 2017
Manuscript accepted: November 13, 2017
Manuscript received: September 29, 2017

Cite this article as

Enninga EA, Ruano R. Fetal surgery for lower urinary tract obstruction: the importance of staging prior to intervention. Minerva Pediatr 2017 Nov 21. DOI: 10.23736/S0026-4946.17.05105-2

Corresponding author e-mail

Ruano.rodrigo@mayo.edu