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REVIEW  NEW TRENDS IN PEDIATRIC SURGERY 

Minerva Pediatrica 2018 June;70(3):263-9

DOI: 10.23736/S0026-4946.17.05105-2

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

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 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 symptoms - Oligohydramnios - Cystoscopy - Urinary bladder neck obstruction - Fetus - Prenatal diagnosis

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