Objective: The aim of this study was to define the natural history of lower urinary tract obstruction (LUTO) with normal midgestational amniotic fluid volumes. Materials and Methods: We performed a retrospective review of 32 consecutive patients with LUTO with normal midgestational amniotic fluid volume followed at 11 North American Fetal Therapy Network (NAFTNet) centers from August 2007 to May 2012. Normal amniotic fluid volume was defined as an amniotic fluid index (AFI) of ≥9 cm. Results: The mean gestational age (GA) and AFI at enrollment were 23.1 ± 2.1 weeks and 15.8 ± 3.9 cm, respectively. The mean GA at delivery was 37.3 ± 2.8 weeks. The mean creatinine level at discharge was 1.2 ± 0.8 mg/dL. Perinatal survival was 97%. Twenty-five patients returned for serial postnatal assessment. Renal replacement therapy (RRT) was required in 32%. Development of oligohydramnios and/or anhydramnios, development of cortical renal cysts, posterior urethral valves, prematurity, and prolonged neonatal intensive care unit stay were associated with need for RRT (p < 0.05) by univariate analysis. By multivariate analysis, preterm delivery remained predictive of need for RRT (p = 0.004). Conclusion: Prenatal diagnosis of LUTO with normal midgestational amniotic fluid volumes is associated with acceptable renal function in the majority of patients. Approximately one-third of these children require RRT. Surrogate markers of disease severity appear to be predictive of need for RRT.

Keywords:
Fetal therapy, Lower urinary tract obstruction, Fetal obstructive uropathy, Oligohydramnios, Posterior urethral valves
1.
Malin G, Tonks AM, Morris RK, Gardosi J, Kilby MD: Congenital lower urinary tract obstruction: a population-based epidemiological study. BJOG 2012;119:1455-1464.
2.
Biard JM, Johnson MP, Carr MC, Wilson RD, Hedrick HL, Pavlock C, Adzick NS: Long-term outcomes in children treated by prenatal vesicoamniotic shunting for lower urinary tract obstruction. Obstet Gynecol 2005;106:503-508.
3.
Robyr R, Benachi A, Daikha-Dahmane F, Martinovich J, Dumez Y, Ville Y: Correlation between ultrasound and anatomical findings in fetuses with lower urinary tract obstruction in the first half of pregnancy. Ultrasound Obstet Gynecol 2005;25:478-482.
4.
Wu S, Johnson MP: Fetal lower urinary tract obstruction. Clin Perinatol 2009;36:377-390.
5.
Ruano R, Sananes N, Wilson C, Au J, Koh CJ, Gargollo P, Shamshirsaz AA, Espinoza J, Safdar A, Moaddab A, Meyer N, Cass DL, Olutoye OO, Olutoye OA, Welty S, Roth DR, Braun MC, Belfort MA: Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity. Ultrasound Obstet Gynecol 2016;48:476-482.
6.
Ruano R: Fetal surgery for severe lower urinary tract obstruction. Prenat Diagn 2011;31:667-674.
7.
Ruano R, Sananes N, Sangi-Haghpeykar H, Hernandez-Ruano S, Moog R, Becmeur F, Zaloszyc A, Giron AM, Morin B, Favre R: Fetal intervention for severe lower urinary tract obstruction: a multicenter case-control study comparing fetal cystoscopy with vesicoamniotic shunting. Ultrasound Obstet Gynecol 2015;45:452-458.
8.
Johnson MP; NAFTNet: The North American Fetal Therapy Network (NAFTNet): a new approach to collaborative research in fetal diagnosis and therapy. Semin Fetal Neonatal Med 2010;15:52-57.
9.
Maizels M, Alpert SA, Houston JT, Sabbagha RE, Parilla BV, MacGregor SN: Fetal bladder sagittal length: a simple monitor to assess normal and enlarged fetal bladder size, and forecast clinical outcome. J Urol 2004;172:1995-1999.
10.
Moore TR, Cayle JE: The amniotic fluid index in normal human pregnancy. Am J Obstet Gynecol 1990;162:1168-1173.
11.
Eugene M, Muller F, Dommergues M, Le Moyec L, Dumez Y: Evaluation of postnatal renal function in fetuses with bilateral obstructive uropathies by proton nuclear magnetic resonance spectroscopy. Am J Obstet Gynecol 1994;170:595-602.
12.
Daikha-Dahmane F, Dommergues M, Muller F, Narcy F, Lacoste M, Beziau A, Dumez Y, Gubler MC: Development of human fetal kidney in obstructive uropathy: correlations with ultrasonography and urine biochemistry. Kidney Int 1997;52:21-32.
13.
Schwartz GJ, Brion LP, Spitzer A: The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am 1987;34:571-590.
14.
Clark TJ, Martin WL, Divakaran TG, Whittle MJ, Kilby MD, Khan KS: Prenatal bladder drainage in the management of fetal lower urinary tract obstruction: a systematic review and meta-analysis. Obstet Gynecol 2003;102:367-382.
15.
Quintero RA, Johnson MP, Romero R, Smith C, Arias F, Guevara-Zuloaga F, Cotton DB, Evans MI: In-utero percutaneous cystoscopy in the management of fetal lower obstructive uropathy. Lancet 1995;346:537-540.
16.
Quintero RA, Hume R, Smith C, Johnson MP, Cotton DB, Romero R, Evans MI: Percutaneous fetal cystoscopy and endoscopic fulguration of posterior urethral valves. Am J Obstet Gynecol 1995;172:206-209.
17.
Johnson MP, Corsi P, Bradfield W, Hume RF, Smith C, Flake AW, Qureshi F, Evans MI: Sequential urinalysis improves evaluation of fetal renal function in obstructive uropathy. Am J Obstet Gynecol 1995;173:59-65.
18.
Freedman AL, Johnson MP, Smith CA, Gonzalez R, Evans MI: Long-term outcome in children after antenatal intervention for obstructive uropathies. Lancet 1999;354:374-377.
© 2017 S. Karger AG, Basel
2017
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.