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Fetal therapy for the treatment of congenital bladder neck obstruction

Abstract

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. Newer techniques, such as fetal cystoscopy, have potential for enhancing prenatal triage and simultaneously delivering treatment. Vesicoamniotic shunting seems to improve perinatal survival, but whether this treatment or conservative management is used, the surviving children have a high rate of end-stage renal failure requiring dialysis and transplantation. Further investigation of long-term outcomes of vesicoamniotic shunting and fetal cystoscopy is hoped to delineate the risks and benefits of these prenatal treatments and inform management strategies.

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Figure 1: Prenatal ultrasonographic findings typical of lower urinary tract obstruction.
Figure 2: Prenatal vesicoamniotic shunt placement.
Figure 3: Effectiveness of antenatal intervention for the treatment of congenital lower urinary tract obstruction.
Figure 4: Fetal cystoscopy for visualization of the fetal bladder neck.

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M.D.K. and R.K.M. contributed equally to researching data for the article, discussing content, writing the article and reviewing and editing the manuscript before submission.

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Correspondence to Mark D. Kilby.

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Kilby, M., Morris, R. Fetal therapy for the treatment of congenital bladder neck obstruction. Nat Rev Urol 11, 412–419 (2014). https://doi.org/10.1038/nrurol.2014.132

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